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THE 



SPHYGMOGRAPH 



ITS PHYSIOLOGICAL AND PATHOLOGICAL INDICATIONS. 



The Essay to which was Awarded the Stevens Triennial Prize, 

by the College of Physicians and Surgeons, 

New York, April, 1873. 



Two hundred and ninety Illustrations. 



EDGAR HOLDEN, A.M., M.D 






PHILADELPHIA: A 
LINDSAY & BLAKISTON. 
1874. 





Entered according to Act of Congress, in the year 1873, by 

EDGAR HOLDEN, 
In the office of the Librarian of Congress, at Washington. 



Jennings & Hardhaii, Printers, Newark, N. J. 



WM. MAXWELL WOOD, M. D., 

late surgeon general u. s. navy, 

In remembrance of acts of kindness, and of association in peril in the 

u. s. navy, and with the hope that the labor bestowed in 

preparation may justify so ceremonious an, act, 

this work is inscribed by 

THE AUTHOR. 



INTRODUCTORY NOTE. 



r-p he work as here presented lias been the resnlt of 
many months of labor, for the field has been path- 
less and virtually unexplored ; but it is hoped that it 
may prove at least a definite and tangible starting 
point for other observers. 

The author desires to state to those who may have 
read his Essay, published by the State Medical Society 
of New Jersey, or that delivered before the New York 
Journal Association, that the views there advanced 
have been found in some cases erroneous, because 
drawn from tracings made as with Marey' s Instrument, 
without the means since adopted for accurately deter- 
mining the compressibility of the artery. 

Since then, moreover, the facilities afforded as 
medical adviser of one of the largest Life Insurance 
Companies of the United States, and as clinical 
physician for diseases of the chest to St. Michael's 
Hospital, have been more liberally drawn upon, 
that previous opinions might be verified or corrected. 



10 INTRODUCTORY NOTE. 

The Essay thus published differs somewhat in form 
from that presented in competition for the Stevens 
Prize, but only as regards a certain diffusedness both 
of tracing and subject matter ; and it is believed that as 
the tracings particularly have been culled with care, 
the work has been made only the more serviceable. 
It may thus be of the more assistance to any who 
desire to pursue the complex yet interesting study of 
Sphygmographic hieroglyphics. 

The reader is desired not to consider the tracings of 
cases as the universal and invariable exponents of 
individual diseases. Such could only be obtained after 
long and patient investigation into every variety and 
phase of disease, and is equivalent to making a new 
symptomatology, a task indeed for a generation of 
observers. They will, however, probably prove in 
all cases suggestive of the pathological condition 
involved. 

Edgar Holden. 

Newark, N. J., October, 1873. 



CONTENTS. 

PART I. 

CHAPTER I. 
GENERAL CONSIDERATIONS REGARDING MECHANISM. 

Vierordt — Professor Marey — Defects of Instruments hitherto — 
Description of Marey's Sphygmograph, and Illustrations of the 
Principle involved — Objections to Pressure upon the Artery — 
Improvements by Professor Sanderson— Advantages of a new 
Principle in Construction — The Pen and its Action — The Pressure 
Spring and its Index — Drs. Anstie and Sanderson on the amount 
of Pressure required — Possibility of Utilizing 17,000 grains — Dial 
described — Value of a Knowledge of the Minute Peculiarities of 
the Arterial Current, 17-29 

CHAPTER II. 
INDICATIONS AFFORDED BY THE PULSE. 

Ideas of the Chinese — Physiological Variations — Quotation from Da 
Costa— and Description of Chief Varieties of Pulse, . 30-38 

CHAPTER III. 
TRANSLATION OF TRACINGS. 

Shock Wave, or First Event — Indications afforded by this— Signifi- 
cance of Amplitude — Wave of Health — Axiom regarding Ampli- 
tude — Error of General Opinion — The Systolic Wave, or Second 
Event, 38-45 



12 CONTENTS. 

CHAPTER IV. 

THE SECOND EVENT. 

Description of Chart — Explanation of Tracings given —Significance 
of this part of the Tracing— Corollaries — The Third .Event — 
Explanation of the Cause of this Event — Wave of Recoil — Refer- 
ence to Cases— Significance of this Event. . . . 45-54 



CHAPTER V. 
THE FOURTH EVENT. 

Opinions of Namnann and Marey — Disproval by Sanderson — Cases 
and Tracings Illustrative— Deductions from a Study of the Trac- 
ings—Experiments with an Artificial Heart and Capillaries, pub- 
lished by New Jersey State Medical Society — New Theory, and 
Facts Substantiating the same — Is Dicrotism always due to Arterial 
Impletion ? — Cases quoted -Dicrotism in Typhous Fever — Dicro- 
tism of Epilepsy — Views of Voisin — Origin and Significance of 
the word Dicrotism — Tricrotism, ..... 54-64 



CHAPTER VI. 

GENERAL PROPERTIES OBSERVABLE BY THE SPHYGMOGRAPH. 

Compressibility — Oscillation, Locomotion, Recoil — Opinion of Dr. 
Corrigan relative to Locomotion of Arteries —Value of a Means of 
Ascertaining Compressibility — Causes and Significance of Oscilla- 
tion — Singular Case in the Practice of Dr. Whittingham of New 
Jersey — Patient of the late Dr. Valentine Mott— Chart and Expla- 
nation of Cases — Summary of Points of Significance of Oscilla- 
tion, 64-74 



CONTENTS. 13 

CHAPTER VII. 

RECOIL. 

Tracings from the Carotid, by Dr. Anstie — Significance of the Wave 
of Recoil — When a purely Physiological and when a Pathological 
Phenomenon, 74-79 

CHAPTER VIII. 

COMPRESSIBILITY OR TENSION. 

Importance of ascertaining the Exact Character and Extent of this — 
Experiments of Prof. Dalton on the Sympathetic Nerves — Investi- 
gations of M. Bernard — Summary-^-Experimental Observations 
with Tracings, 79-86 



PART II. 



CHAPTER I. 

THE PRACTICAL APPLICATION OP THE SPHYGMOGRAFH. 

General Considerations — Reduction in the number of Tracings Given, 
and the Reason therefor — Practical Suggestions to Observers, 

86-91 

CHAPTER II. 

DESCRIPTIVE NOTES IN CONNECTION WITH TRACINGS. 

Cases of Apparent Health— Influence of minor Disturbing Causes — 
Wider Deviations, suggestive of existing Disease -Debility — Hys- 
teria—Tobacco Poisoning — Influence of Loss of a Limb on a Trac- 
ing, 91-101 



14 CONTENTS. 

CHAPTER III. 

CASES CHIEFLY OF CARDIAC DISEASE. 

Irregularity due to mitral disease — Opinion of Prof. Sanderson— Ver- 
tigo — Description of the Cases and Tracings — Functional and 
Organic Disease, 101-113 

CHAPTEE IV. 

AFFECTIONS OF THE NERVOUS SYSTEM. 

Mania-a-potu — Opinions of a Celebrated Observer, . . 113-114 

CHAPTEE V. 

SAME CONTINUED. 

Asthma and its Varieties — Cardiac Dyspnoea— Bronchitis — Progresso- 
loco-moto-ataxia, 114-121 

CHAPTEE VI. 

SINGULAR CASES OF DOUBTFUL DIAGNOSIS. 

Epilepsy— Rheumatic Arthritis, 121-128 

CHAPTEE VII. 

PHTHISIS, ITS VARIETIES, WITH CASES AND TRACINGS OF SAME. 

Selection of Tracings from Several Hundred — Detail of Cases— Acute 
Phthisis — Latent Phthisis — Chronic Phthisis — Aneurism— Impos- 
ture Detected, 128-133 



CONTENTS. 15 



PART III. 

CHAPTER I. 

ACTION OF MEDICINES. 

Detection of Effect prior to any Sensible Manifestation— Drugs Se- 
lected — Time of Commencing Observations — Facility with which 
Examination can be Made by the Experimenter on Himself— Can- 
nabis Indica — Minuteness of Detail — Alcoholic Extract — Twelve 
grains taken. 

Second Experiment — Instrumental and Physiological Observations 
Compared— Tincture Cannabis Indica — One Hundred, and, Ten 

Drops Taken ! 

Third Experiment — New and Fresh Tincture— Comparison of Sensa- 
tions with Records — Four Hundrtd and Twenty Drops Taken! 

Fourth Experiment — Fresh Alcoholic Extract — Terrific Excitement 
from Poisoning — Twenty six Chains taken in Two Hours and 
Forty Minutes ! 

Synopsis of Effects— Tracings of the following Day — General Deduc- 
tions as to Effects of the Drug, 133-149 



CHAPTER II. 

EXPERIMENTS WITH GELSEMINUM SEMPERVIRENS. 

Reason for Selecting the Drug — Difference of Opinion among Medical 
Authorities — Sensible Effects — Opinion of Dr. Da Costa — Amount 
Taken— Effects Observable only by the Sphygmograph — Deduc- 
tions, 149-153 



16 CONTENTS. 

CHAPTER III. 
EXPERIMENTS WITH ACONITE. 

Fluid Extract Taken— First Case a Young Lady — Amount Taken — 
Interval before Circulation was Affected — Maximum and Minimum 
of Excitement — Arterial Tension — Deductions and Comparisons — 
Value to Pathology, 153-158 

CHAPTER IV. 

EXPERIMENTS WITH QUININE. 

Small Doses — Single Small Dose and its Action on the Pulse — Re- 
peated Doses — Effect on the Nervous System— Deduction, 158-162 

CHAPTER V . 
CONCLUDING REMARKS. 

What has been Attempted in this Essay — A Construction of the In- 
strument Justified — A Discussion of the Value of a Knowledge of 
hitherto Undeveloped Features — The Power of the Instrument to 
Develop these, 162-163 

Index, 165-169 



THE SPHYGMOGRAPH : 



ITS PHYSIOLOGICAL AND PATHOLOGICAL INDICATIONS. 



PAET I. 

CHAPTER I. 
GENERAL CONSIDERATIONS REGARDING MECHANISM. 

A Sphygmograph is an instrument which can 
automatically record the peculiarities of the arterial 
pulse. According to Vierordt, to whom we are pro- 
bably indebted for its suggestion, it was simply "an 
instrument which, when applied over an artery, indi- 
cated its character as to force and extent of undula- 
tions," and, as originally constructed, could accomplish 
this only with difficulty and uncertainty. More 
recently the ingenious device known as Professor 
Marey's, showed a wider significance in the sphyg- 
mographic tracing, and gave promise of great practical 
usefulness. It is no disparagement of the invention 
to say, that the sanguine hopes entertained with 



18 THE SPHYGMOGEAPH. 

regard to it have not been fully gratified, and that 
to no inconsiderable extent the disappointment has 
been due to certain imperfections in the instrument 
itself. These, however, have arisen mainly from a 
want of ready applicability, and a tendency to fall 
out of repair, from the very perfection and refinement 
of its own mechanism. 

As the word Sphygmograph is, to most of those who 
know of the device, intimately connected with the 
name of Professor Marey, it is but proper, before 
presenting results obtained by other means, to allude 
to the principles, merits and defects of his invention. 

This may perhaps be more briefly done by present- 
ing a skeleton diagram of the instrument, or rather 
endeavoring by an outline drawing, to illustrate its 
action. 

A simple lever, attached at one extremity, rests at 
the other upon the artery to be examined, and com- 
presses it, therefore, in a vertical direction ; a second 
lever, bent at a right angle and lying directly above 
this, communicates its motion by a knife edge to a 
third, and this latter, which is at the same time the 
tracer, and has upon its free extremity a peculiar pen, 
amplifies or magnifies the motion communicated. 
This amplification is simply due to the fact that, as 
will be seen by the drawing, the motion is directed 
against the tracer very near its attached extremity. 



THE SPHYGMOGRAPH. 



19 




Artery. 
F— Points of attachment of levers. 



P— Pen. 



S— Screw. 



A screw, near the same point, traverses the tracer 
and regulates the pressure. The other parts of the 
instrument, being simply accessories, with perhaps the 
exception of a concealed watch movement, designed 
to move the paper to receive the writing, need not be 
described. 

This instrument is strapped to the wrist to insure 
immobility ;* and in the hand of its inventor has 
developed features in the arterial pulse never before 
discerned. Inasmuch, however, as disappointment 
has resulted from its subsequent use, and its delicacy 
and cost have limited the observations which should 
be manifold, within a narrow scope, it is a fair inquiry 
whether this disappointment may not after all be due, 
not to a meagre pathological or physiological value of 
the pulse-wave, but to some defects in the instrument 
employed. 

A glance at these may both answer inquiry and 
suggest a change. 

In the first place, the end of the lever, which may 
be called the pulse-spring, rests upon the artery and 



20 THE SPHYGMOGRAPH. 

compresses it, as already remarked, in a vertical direc- 
tion. Tims, as may be seen in the following drawing, 
any increase of pressure flattens the vessel, and, 
as will be shown in speaking of amplitude of 
tracings and arterial tension, a deceptive result is 
obtained. 

The movements of the spring are, as observed by 
Sanderson, not therefore those of the arterial wall in 
the fullest sense, and extent of motion is inaccurately 
measured. 

As an artery is distended laterally as well as verti- 
cally, some of the peculiarities of the contained wave 
are of necessity lost ; especially when the current of 
blood is small, and the flaccidity of the vessel consid- 
erable. 

The second defect, as will be conceded by all 
observers, lies in the method necessary to secure the 
instrument to the wrist. This is done by straps, or 
rather a bandage, which hooks in alternate loops over 
wire pegs on the sides of the instrument, or may be a 
continuous and single band with straps and buckles. 
The difficulty. of adjustment to the artery, even under 
favorable circumstances, is considerable ; and when 
the patient is nervous and excited or frenzied by delir- 
ium, the tracing obtained after a prolonged trial cannot 
be accepted as the correct index of the pulsating 
wave. Indeed, so great is the liability to obtain an 



THE SPHYGMOGKAPH. 21 

inadequate or erroneous tracing, that many observers 
have cast the instrument aside, as unworthy the expen- 
diture of time and patience. 

Much has, however, been accomplished in the way 
of remedying this defect by the patient efforts of one 
to whom much reference must be made in this essay — 
as having, more than any other, endeavored to render 
the Sphygmograph of Marey of practical benefit — 
Professor Burdon Sanderson. Yet, after all, his de- 
vices did not perfectly obviate the defect last referred 
to ; and only modified it in so far that the involuntary 
muscular movements in the wrist of the patient would 
not impair the tracing. 

He adjusted slips of brass to the instrument in such 
a way that the body of it rested more firmly upon a 
surface of bone ; but an elastic band was made neces- 
sary for the retention of this, and this added to what 
was a much underrated and additional defect, viz., 
obstruction to superficial venous circulation by the 
retaining straps. To be sure, this obstruction would 
of necessity be slight, but, in obtaining a record, the 
nicety of whose indications depends upon such minute 
particulars, even so slight an obstruction miglit vitiate 
our results. 

To what extent this is actually the case, will be seen 
by reference to the direct experiments made in this 
direction, and recorded in this essay. 



22 THE SPHYGMOGRAPH. 

The third, and, as will be shown by a multitude of 
observations, vital defect, is the inability to accurately 
and quickly determine the compressibility of the 
artery. 

By the adjustment of the brass slips referred to, 
some improvement resulted, inasmuch as, after a series 
of experiments with various weights, an approximate 
relation could be arrived at between the distance from 
the surface of the lever to the spring, and the actual 
pressure at the time upon the artery. 

Other workers adopted various devices to remedy 
this defect, one only, however, seeming to be a real 
improvement, viz., that of graduating the screw ac- 
cording to a pre-arranged scale, and thus having at 
hand an index upon the screw itself. By reference to 
the drawing, it will, I think, be manifest, that the 
defect consists in the screw itself, since it bears like an 
inflexible brake upon the levers with which it is in 
contact, and when we shall consider this compressi- 
bility as one of the most important elements in the 
arterial current, it will be seen that its ready and 
accurate record are essential to any real practical use- 
fulness of the instrument. 

Recognizing, then, the importance of having as few 
defects as possible in the device we employ to record 
the peculiarities of the pulse, and feeling indeed that 
the question of real moment does not relate to the 



THE SPHYGMOGKAPH. 23 

practical utility of any given Sphygmograph, nor yet 
of the Sphygmograph, in its best known signification, 
but to whether there is any deep meaning in the blood 
current of the accessible arteries, of value in Physi- 
ology, Pathology or Therapeutics, which can be accu- 
rately ascertained and recorded, I have endeavored to 
remedy the defects enumerated, as the best method of 
answering the question in hand. 

Despairing of any success in the direction taken by 
the eminent observers of England and the Continent, 
after their but partial success, it occurred to me that a 
new principle of construction might accomplish better 
results. In all instruments thus far adopted the 
attempt had been made to employ the lifting power 
of the current of blood to obtain a tracing, the diffi- 
culties of friction and amplification being the problems 
to be solved. 

The arrangement of the levers and the shape and 
position of the tracing point, already considered, are 
probably the most perfect adaptation of mechanism in 
this direction. (See first Frontispiece.) But instead 
of attempting to utilize the lifting, why not employ 
the displacing power of the artery % Instead of having 
the spring press doion upon the 
artery, let it partially surround it, J 

thus : Then with each pulsation ""\ ^W ^"^ 
a force is transmitted not only up- "€K 



24 THE SPHYGMOGEAPH. 

ward, but in an oblique direction, as shown by the 
dotted lines, the preponderance being toward the side 
upon which the spring may be inclined. Prolong the 
pulse spring, and shorten the distance between the 
point of attachment (the fulcrum) and the point of 
pressure, and this upward and oblique movement is 
evident to the eye. To amplify this, allow the free 
and distal end to be bent as an inclined plane or 
the curve of a circle ; polish it to obviate friction ; 
magnetize it, if desired, to add a repellant power to 
the power already evident, and allow it to impinge 
against another lever quite near its attached extremity, 
(a lever of the third order) ; make this last flexible, 
and its distal end will move with regular, accurate 
sweep under the distensile power transmitted. 

The skeleton drawing below will illustrate more 
perfectly the principle involved. 

B 




Artery. 

B — Place for Pen. P — Pulse Spring. F — Attachment of Flexible Lever, i. e. 
Tracer. 

The movement obtained by this means is from side 
to side, and not, as in Marey' s instrument, in a vertical 
direction ; and in consequence the paper to receive the 



THE SPHYGMOGRAPH. 25 

tracing may lie as in ordinary writing. (See design 
on second Frontispiece.) The accessories necessar}^ to 
the application of this principle need not be described 
in detail ; they are simply a framework of brass ; a 
sliding-post for the attachment of the tracing-lever by 
which it may be brought in apposition to the inclined 
plane described ; a watch movement for moving the 
paper to receive the writing ; and a means for holding 
the instrument in the thumb and finger over the 
artery. The drawing on the second page may render 
this description more intelligible. Two points, how- 
ever, of importance, are worthy a moment's notice, 
viz., the pen, and the means for determining and 
recording the compressibility of the artery. 

As already stated, the motion obtained is from side 
to side, and although ample, it is yet so delicate that a 
hair upon it stops it at once. After many disheartening 
attempts to utilize chemical re-agents, and the sugges- 
tions of various persons of ingenuity, the simple plan 
of pivoting the writing-point — in fact an ordinary pen 
— and thus making the paper and not the delicate 
lever carry the weight, solved the problem — thus : 




To ascertain with precision the pressure necessary 



26 THE SPHYGMOGRAPH. 

to obtain an ample tracing, it was evident that no 
power should be brought to bear upon the pulse, 
except that of the pulse-spring itself, since relative 
compressibility could only be accurately determined 
by variations of the intensity of a common force. The 
increase or diminution of pressure should therefore be 
ratios of the ability of the spring itself; in other 
words, the spring should have within itself the power 
to press lightly or heavily upon the artery. Its 
attachment to the body of the instrument was there- 
fore made by a coil of watch-spring, whose tension 
could be controlled and measured on a dial, at will, 
an amount of pressure being possible beyond any 
requirement, and reaching four, five or six pounds. 

The drawing illustrates both the coil and the record- 
ing dial. 




It will be at once evident, that coiling the spring 
from its centre, A, will bring a pressure just in the 
very direction most desired, viz., downward and back- 
ward against and upon the vessel as indicated by the 



THE SPHYGMOGRAPH. 27 

dotted line. A curved wire, B, acts both as a brake 
to prevent the uncoiling of the spring and maintaining 
it at any desired point, and also as an index for the 
dial. 

As the best and only test for the utility of any 
invention, is the amount and character of the work it 
will accomplish, more minute description may perhaps 
be dispensed with, and reference made to the charts 
presented in a subsequent part of this essay. 

A few words of comment on the extent of pressure 
sometimes necessary, appear, however, in place at this 
point. 

Most observers, especially Drs. Anstie and J. Bur- 
don Sanderson, have found that a pressure of 100 
grammes is the average minimum, and that by the 
device of the latter a variation of 200 grammes is easily 
attainable ; this is equivalent to about 3,000 grains. 
It will be observed on the charts appended, that 700 
grammes were often necessary ; and it may be added, 
that in some cases I have found it possible to obtain 
a tracing under a pressure of 1,100, or about 17,000 
grains. 

The dial already described is, as will be seen in the 
drawing, marked in degrees, the equivalent of each in 
grains being easily determined by the equipoise of 
weights upon a balance. The following exhibits the 
amount of pressure exerted when the spring is coiled 



28 THE SPHYGMOGKAPH. 

sufficiently to bring the index opposite each degree : 
° — about 100 grammes, or 1,560 grains. 
2i° " 186 " 2,880 

5 ° " 690 " 10,620 

Somewhat singularly, the application of this different 
principle gives results similar, and therefore readily 
comparable with those of Professor Marey, and al- 
though the celerity and certainty by which the com- 
pressibility can be ascertained has often developed 
features of a pulse-wave that would have been con- 
cealed without this, yet the tracings are so nearly akin 
that they may be explained and treated under the 
same rules as his own. 

Whether the defects that have so nearly wrecked 
the science of Sphygmography, ere it had well begun 
its career, have been fully corrected by the means 
described or not, the reader, who will patiently review- 
the results obtained, will be able to judge. 

Two elements, at least, toward the success of the 
instrument as an aid to science, will, I think, be 
conceded to the change in its construction, viz., a 
reduction in cost down to a reasonable and available 
point,* and a more ready applicability. 
Most of the tracings delineated on the charts were 



* Note. — The instrument used for this work has not become disarranged 
or out of order after several thousand tracings, and could be duplicated by 
the maker at a cost of about one-third that of the imported instrument. 

Otto & Keynders, Inst. Makers, New York. 



THE SPHYGMOGRAPH. 29 

taken during an ordinary visit, and occupied only from 
thirty seconds to two minutes ; no fastenings were 
employed, and no preparation necessary, not even in 
most instances the preliminarjr rolling- up of the sleeve, 
save barely to uncover the radial pulse. The instru- 
ment was held by the linger and thumb of the left 
hand, the paper introduced, the ink applied, and the 
watch-work started by the other. To a great extent, 
therefore, nervous excitement due to the simple act of 
examination has not vitiated the tracing, and it is be- 
lieved that so far as Sphygmographic observations can 
be the true record of the pulse-waves, these are reliable. 

Of the many other devices for ascertaining and 
recording the peculiarities of the pulse, from the 
simple column of mercury and the. semaphoric regis- 
tration by the aid of photography, to the attempts to 
utilize the galvanometer, it is unnecessary to speak ; 
since their failure hitherto to develop better results 
than their predecessors, has not yet brought them a 
measureable success. The subj ect of chief interest is, 
after all, outside of any particular method; of observa- 
tion, and relates to the observations themselves. 

We may, perhaps, the better define the true physio- 
logical and pathological indications in these by dis- 
cussing, first, the actual value of a knowledge of the 
minute peculiarities of the circulatory current, and 
then, the power of an instrument to develop them. 



CHAPTER II. 

INDICATIONS AFFORDED BY THE PULSE. 

The pulse, from the earliest record of historic medi- 
cine, has been to the Physician a guide and instructor ; 
and, although the elaborate anatomical knowledge of 
the present day has divested it of the mysterious ele- 
ment so familiar to the student of ancient medicine, 
and we no longer profess to divine or prophesy by 
its aid, it is still, in many cases, the key to our 
patient' s condition, and in all a valuable assistant in 
diagnosis. 

Nor can this be due merely to the effect of education, 
or the example of our predecessors. Every skillful, 
ambitious physician realizes in daily life that the 
"tactus eruditus" is to-day as valuable an acquire- 
ment as in the days of Galen. We may no longer 
hide our ignorance under the look of deep and digni- 
fied wisdom, or with our fingers on the pulse shake 
our heads with complacence, while puzzling confusedly 
over the remedy it would be best to hazard on the case. 
It is our privilege to have within our reach ample 
means of information, and neither to over or under- 
rate the significance of the pulse we feel. To do this, 
however, it is not sufficient that we be versed in 



THE SPHYGMOGRAPH. 31 

anatomy or physiology ; for, as we realize to-day that 
we can read a deeper meaning in its throbbings than a 
year ago, so each year' s experience shows new indica- 
tions to our more practiced touch, and we feel that 
without it we should be . often in doubt, when doubt 
might be fatal to our patient. We are wont to regard 
as absurdities many of the notions of the early physi- 
cians, simply because the better facilities of modern 
times have shown their deductions to have been un- 
tenable ; but we overlook the fact that, although shut 
out from our refinement of pathology, they were yet 
not devoid of wisdom, and, drawing largely from 
experience, often showed that the homage and respect 
bestowed upon them were well deserved. "We deride 
the assumption of mystery, although it is fast becom- 
ing evident in the present age, that its absence is far 
from beneficial. 

There is, perhaps, no better aid to the success of 
the charlatan of to-day, than the arrogance grown out 
of a little knowledge that presumes to weigh for itself 
questions of disease and treatment. The contempt of 
familiarity has taken the place of the faith that once 
helped to cure. 

We may be, however, and probably are right in 
regarding the diffuse nomenclature and labored at- 
tempts to make of pulses critical guides to treatment, 
as not particularly wise, yet in the days of Solano it 



32 THE SPHYGMOGRAPH. 

is not improbable that they possessed value, crude 
and imperfect it may be, but value of which we with 
better information have no knowledge. 

This concession can hardly be made, however, to 
the Chinese of even our own day, by whom the pulse 
of one wrist is believed to indicate the disease of one 
organ, that of the axillary artery of another, and who 
pretend by the femoral pulse of a pregnant woman to 
determine the sex of her child ; yet even in this 
extreme tax upon credulity there is more of good 
sense than we are at first inclined to believe ; and the 
fact was strongly suggested during a series of exper- 
iments with an artificial heart and system of vessels 
to which allusion will again be made in this essay, e.g. 

Upon ligating one of the capillaries in a network 
of interlacing tubes, the quantity of fluid forced 
through them remaining the same, very little disturb- 
ance or change appeared to have been caused in the 
others, at least so far as the touch could decide ; and 
yet it was evident that a larger quantity of fluid was 
compelled to find its way through them than before. 
A Sphygmograph however, indicated a difference ; 
and when two or more were ligated, a perceptible 
difference was observed by the fingers. Apply this 
fact to the human body: suppose, for example, a 
mass of enlarged lymphatics obstructing the subcla- 
vian artery ; if this obstruction were slight, the differ- 



THE SPHYGMOGBAPH. 33 

ence in the feeling of the axillary artery might be 
perceptible, while the radial, being smaller and more 
distant, wonld appear to be unchanged ; or, suppose 
an engorged liver, or spleen, or hepatized lung, it is 
by no means irrational to assume that some change 
would occur in even a remote artery. Our experience 
with the fact that ligating a limb will check an hemo- 
ptysis or other hemorrhage exhibits the same fact. 
Out of similar observations may possibly have grown 
the whimsical oddities of the Chinese. 

What the change in the arterial wave, remote from 
the source of disease, may be, we may not be able 
accurately to determine ; but in the artificial system 
referred to, it was a peculiar oscillating feel, sometimes 
a thrill, and more frequently an increase in the fullness, 
suggestive of the pulsus magnus et durus of old 
writers. The Sphygmograph, however, may yet be 
able to determine this with approximate certainty ; 
and, though we laugh at the Chinese, it is not impos- 
sible that it may reveal a difference between the right 
radial and the left, when an organ on the right side is 
the seat of disease. 

Laying aside Sphygmographic definition, the pulse 
may be briefly defined to be the perceptible distension 
of those arteries of the body which are accessible to 
touch or sight; and in a purely physiological sense 
the distending process may exhibit singular variations. 



34 THE SPHYGMOGEAPH. 

There are some that are marked and familiar. The 
variation may be that of interval (increase or diminu- 
tion in frequency), as under emotion, fatigue or exer- 
tion. Rarely it may be that of rhythm, the beats 
being unequal or intermittent ; this, however, is more 
frequently other than a physiological variation. The 
most common form of it is probably that in which 
the period of rest is prolonged, due to a derangement 
of the sympathetic system. To say that it is, or may 
ever be, a purely physiological variation, assumes, I 
am aware, to decide a question concerning which differ- 
ence of opinion exists. 

It may be a variation of volume, as in the plethora 
of the young and robust, so long as this falls short of 
disease ; more strictly this is exemplified during the 
contraction of the capillaries from cold. 

The variation may be one of duration of impulse— 
that is to say, the distension may be soft and even, or 
have a sharp accentuation due to nervous excitement. 
The latter change is commonly accompanied by a 
sense of vibration when the ear is applied over the 
heart. 

The shades of variation are more clearly expressed 
in the Sphygmographic writings, on charts 1, 2, 3, 4 
and 5. 

Pathologically, the variations of the pulse are of 
of greater significance ; thus changes in frequency 



THE SPHYGMOGRAPH. 35 

may indicate the wide departure from health of cere- 
bral disease or excessive fever, or the steady sapping 
of vital energy in any constitutional disease, when, as 
expressed by Latham, it has engaged the nervous sys- 
tem perilously. Quickness , as distinct from frequency, 
assumes a new signification, as in phthisis or inflam- 
matory fever, or the impaired and irritable heart of 
dissipation, or excessive use of tobacco. 

Volume, in a pathological sense, becomes the index 
of cerebral compression, of blood poisoning, of hyper- 
trophy, or the loss of contractile tone of the artery 
itself. 

The variation of rhythm is still more important, 
whether as the precursor of a gouty paroxysm — of the 
action of certain poisons, as of digitalis or colchicum ; 
or as indicating mitral disease (Sanderson), or fatty 
degeneration (Dr. Todd). 

Strength, as indicative of increased tonicity ; and 
weakness, as of dilated left ventricle, or unhealthy 
blood ; of ebbing life in cancerous disease ; or the 
debility of innutrition, are qualities most familiar. 

Tension, or resistance of the pulse, finally offers to 
the touch a guide of considerable importance ; and 
when we shall come to consider its pathological value 
from a sphygmographic point of view, will be seen to 
deserve more than passing notice. 

The arteries, full to repletion, are incompressible, be- 



36 THE SPHYGMOGKAPH. 

cause unable to free themselves from the accumulating 
blood with sufficient rapidity, and the fullnes may be 
due to either interference with avenues of escape in 
front (the capillaries), or exaggeration of quantity of 
fluid forced into them from behind (over-working 
heart). In the former case a deranged sympathetic 
system may be indicated, and in the latter an hyper- 
trophied left ventricle. 

Before proceeding to the consideration of these varia- 
tions from a sphygmographic stand-point, the cursory 
and brief manner in which they have been reviewed, 
suggests a summary, and probably no better could be 
given than by quotation from the work of Da Costa, 
on Medical Diagnosis, pp. 38 and 39 : 

" A hard, full, frequent pulse occurs in active inflam- 
mations, and in most of the acute diseases of 
robust persons. 

A hard pulse, full or small, bounding or not, if 
unconnected with acute symptoms, leads to the 
suspicion of cardiac disease, or of an affection of 
the artery itself. 

A tense, contracted and frequent pulse is met with 
in a large group of inflammations below the dia- 
phragm, as in enteritis, peritonitis and gastritis. 

A frequent pulse, full or small, but rarely tense, is 
the pulse of most idiopathic fevers. 

A very frequent pulse, but very feeble and compres- 



' THE SPHYGMOGRAPH. 37 

sible, is the pulse of marked debility, of prostra- 
tion, of collapse. 
A pulse frequent and changeable in its rhythm, is 
produced for the most part by disease of the heart 
or of the brain." 

More particular features of the pulse-wave developed 
by the instrument we are considering, such as are due 
to elasticity, contractility or locomotion of the vessel 
itself, the relative tension of the venous and arterial 
systems, the condition of the capillary structures, etc., 
may be better dwelt upon, after an endeavor to under- 
stand the hieroglyphics themselves. 



CHAPTER III 



TRANSLATION OF TRACINGS. 



The different portions of a sphygmographic tracing, 
which possess any appreciable meaning, are termed 
the events of the tracing. 

The first event, is the sudden, primary ascent, or 
shock-wave. 

The second event, is the true systolic wave, or wave of 
filling of the vessel with blood. 

The third event, is the diastolic collapse, or descending 
wave, the line permitted by the emptying of the 
artery. 

The fourth event, has generally been considered the 
diastolic expansion or recurrent wave — the wave of 
dicrotism. 

(In order to introduce no new element of confusion, 
into our subject, it will be so considered in this essay, 
although in some tracings there appears a wave evi- 
dently preceding this, viz., that of recoil. Instead of 
making it a new event, it will be introduced like com- 
pressibility as one of the general elements of a tracing.) 



THE SPHYGMOGRAPH. 39 

The s7iocJc-ioave, or first event. 

Sphygmographically, the pulse-wave is found to 
indicate several distinct occurrences. If the artery be 
full when the heart contracts and discharges its blood 
into the aorta, the first occurrence is a swiftly trans- 
mitted impulse, similar, as pointed out by Professor 
Sanderson, to that conveyed through a series of balls 
suspended in a straight line. Upon striking the first 
of the series the last or outer one only is propelled. 

(As explained by him, when objected that this 
occurs only with elastic bodies, and that blood is not 
elastic, the elasticity of the arteries by a well-known 
law gives to their inelastic contents their own pro- 
perty). This transmission may, if the artery be full, 
be almost instantaneous, and is important to the pro- 
per understanding of all tracings. The writer quoted 
has ascertained that this transmission is at the rate of 
about ninety feet per second. It is at any rate 
frequently exhibited by a sudden ascent of the trac- 
ing just ahead of the filling of the artery ; and is 
consequently the cause of the first wave, under the 
circumstances named, and indicates either one of three 
things (see example A) : 

A A 



40 THE SPHYGMOGBAPH. 

1st. Increased vigor 'of contraction of the heart, as in 
hypertrophy of the left ventricle. 

2d. Increased irritability, dne to disease of the sym- 
pathetic system. 

3d. Increased irritability, due to simple nervous ex- 
citement. 

The amplitude of this initiative wave is in direct 
2?roportion to tension. 

The distinction between tracings in which this fea- 
ture is due to pathological change and those in which 
it is a purely physiological event, may not always be 
easy, but even if it were supposable that ordinary 
means of auscultation and percussion were not avail- 
able, or, as in the case of a deaf examiner, such 
assistance to diagnosis were impossible, there are yet 
two points of difference of great value : one, the per- 
sistence in disease, of increased impulse, as communi- 
cated to the hand applied over the apex of the heart — 
tending rather to increase during the sitting, and. 
exhibiting a peculiar heaving motion (and suggestive, 
as observed by Walshe— p. 223, Dis. of Heart — of a 
pressure forwards, steadily against an obstacle) ; its 
increase, moreover, in extent, and quite frequently the 
lowering of the point of apex beat. 

The other point of difference lies in the amount 
of pressure required to bring out the peculiarity. 



THE SPHYGMOGEAPH. 41 

Generally, unless when the disturbance of the sympa- 
thetic is sufficient to amount to disease, as in excessive 
use of tobacco, the increase of pressure tends to oblit- 
erate it in the simple form, while in hypertrophy a 
great pressure rather exaggerates it. (It is to be 
remarked, that simple hypertrophy of the left heart is 
now referred to, without dilatation or valvular disease ; 
these complications presenting changes in the tracing 
peculiar to themselves.) 

Should a diagnosis in any given case be of import- 
ance, the action of proper remedies and the disappear- 
ance of the wave under their use would be sufficient 
to establish it, for it may be here remarked that this 
wave of a tracing is by no means an essential one. 
The normal tracing of perfect health is generally a 
single symmetrical wave, of which the following is an 
example : 



And in this the transmitted impulse which we have 
described as causing a wave of shock, is merged into 
the next or true systolic wave, . the wave of distension 
or simple filling. 

This, which has usually been described as the second 
event, is most marked when the artery is a little less 
than full at the time of its occurrence ; and it is the 
prominence of this which is referred to in the axiom of 



42 THE SPHYGMOGEAPH. 

Marey, that "amplitude of a tracing is in inverse ratio 
to the tension." 

With the instrument I have used, this axiom is cor- 
rect only in a very limited number of cases, and as 
only the power of an instrument to ascertain and 
record pressure with readiness could demonstrate this, 
it may here be the best opportunity to refer briefly 
to it. 

A moment' s reflection would seem to make it certain 
that if an artery be partly empty, a wave transmitted 
through it would lift its surface higher, and conse- 
quently give a wider tracing than if already full ; but 
supposing the amount transmitted be the same in both 
cases, the statement could be true only if the disten- 
sible quality of the vessels were within narrow limits, 
as is the case when their coats are diseased, and the 
quantity of the fluid therefore forced to pass more 
slowly ; and I have not been surprised to find that as 
the vis-a-tergo remains in both cases the same, and the 
distens%le quality of the artery is -very great, the am- 
plitude bears no determinate ratio to the fullness of 
the vessel, i. e. the tension. In many instances, as 
will be seen upon the charts appended, a tense artery 
which will bear the highest pressure, gives the greatest 
amplitude of tracing. 

The explanation of this apparent discrepancy of 
observation, probably lies in the fact already alluded 



THE SPHYGMOGKAPH. 43 

to, viz., the adjustment of pressure in the instrument 
used, for if a uniform rate be employed in all cases 
the axiom would be universally true. With facilities 
for adjusting pressure, the axiom might be that " am- 
plitude of systolic wave appears in inverse ratio to 
tension when a uniform pressure is maintained upon 
the instrument used, Met often bears a direct ratio to 
it when a graduated pressure is employed" The 
reason for this distinction will be obvious when con- 
sidering the physiological and pathological signifi- 
cance of tension and its measure, compressibility. It 
may be more clearly explained by the observation, 
that when we press firmly upon or into the distended 
artery we obtain a measurement not so much of the 
distension of the vessel as of the force employed for 
its dilatation. 

The systolic toave, or second event. 

Theoretically, in a pulse we should have but two 
events, viz., the filling of the artery, which is more or 
less quick, owing to the character of the heart's action, 
and its emptying, which is more or' less slow ; and 
practically these are the essential elements to be con- 
sidered, for it is evident that by the former would be 
shown any increase or diminution in the filling force, 
i. e., any increase or decrease of vigor in the heart's 
action, or any interference with the current by pres- 



44 THE SPHYGMOGBAPH. 

sure or otherwise between the heart and point of 
observation ; and in the latter, i. e., the emptying of 
the artery, would appear any distal obstruction, 
whether capillary or venous. 

With the first of these we have to do in considering 
the systolic wave, or second event. As already ob- 
served, it is sometimes merged into the shock-wave, 
which should precede it. It is sometimes not at all 
discernible as a wave of distension, because merged 
into a quickly succeeding wave of impulse, and is 
subject to greater variations than any other part of 
the tracing. 

It was formerly supposed to be most fully developed 
in the pulse of old age. In the following hypothetical 
tracing it is indicated by the letter B B 

B, and represents in the artery the 
systole of the heart. 

It is quite frequently almost impossible to determine 
whether it is postponed in the tracing, and so appa- 
rently hidden by a reflex wave yet to be considered, 
or really takes the place of that wave. 

The reader may in such cases be able, from the 
amount of material furnished, to form an independent 
opinion. 




CHAPTEE IV 



THE SECOND EVENT OP A TRACING. 



The tracings on the chart opposite this page are ex- 
amples of varieties in this wave, including some that 
may be subject to two interpretations. 

The first is the tracing of a healthy person whose 
pulse generally gave a plain smooth wave, but who in 
this case was under the slight influence of the fluid 
extract of gelseminum sempervirens, taken for exper- 
iment. It is peculiar in nothing save the smoothness 
with which the wave of systole is developed. 

The second is of the same person, under widely 
different circumstances. The systolic wave begins 
without marked ascent, apart from the shock -wave, 
and is indeed probably merged wholly in it, and 
were it not for the slight indication of the two events 
exhibited in the first apex of the writing, we might 
suppose the shock- wave to be absent. The fullness of 
the artery is prolonged almost to the beginning of the 
succeeding pulsation. This was due to the slow emp- 
tying of the capillaries, a condition arising purely 
from derangement of the sympathetic system from 
over-taxation and fatigue. 



46 THE SPHYGMOGRAPH. 

The third is an example from a healthy woman, 
twenty-four hours after delivery, and after and during 
a profuse metrorrhagia. This rounded wave has 
usually been considered the evidence of slow empty- 
ing of the capillaries, and almost always as indi- 
cating impairment of the coats of the smaller arteries. 
Example number six, which follows, illustrates this 
condition ; but there is an abundant evidence to show 
that this is a far too limited signification. The case 
we are considering is an evidence of this, for since that 
observation was made, tracings have been perfectly 
normal. Other examples on the same chart show that 
no degeneration of arteries would be likely to exist, 
owing to the youth of the parties. 

In the present instance the explanation probably 
lies in the fact that the heart failed to fill completely 
during its diastole, and therefore lacked the customary 
stimulus of impletion, for no obstruction to circulation 
seems to be indicated in the tracing. 

The fourth is the record of a man subject to epi- 
lepsy, but in whom no organic affection of heart or 
other thoracic viscera could be detected. This variety 
is frequently met in organic disease of the heart, but 
generally only when cerebral symptoms have also 
given trouble. 

The fifth is that of an hysterical female, with no 
disease except uterine anteflexion— the only source of 



THE SPHYGMOGRAPH. 47 

annoyance in the case arising from globus hys- 
tericus. The peculiar elevation of the systolic wave 
above the first is an unusual event where no disease 
exists, and in this case was probably due to the 
volume of blood discharged into the aorta with each 
pulsation, and a perfectly unobstructed capillary 
delivery. In such cases tracings may vary singu- 
larly, during a sitting, since any of the disturbances 
of the capillary circulation, so common in hysteria, 
may at any moment occur, and a state of arterial 
or venous tension change the whole character of the 
record. 

The sixtli exhibits the compressible artery with 
weak heart and degeneration of arteries of a patient 
eighty-one years old, suffering from chronic phthisis, 
and frequently from venous engorgement. This latter 
condition, which properly belongs for description 
under the subject of "tension," was in this instance 
always the precursor of an increase of cough and other 
troublesome symptoms, which compelled the patient 
to take to the bed. 

Singularly emaciated, the veins of the body at such 
times, where most superficial, were prominent, dark 
blue and distorted. It is impossible to conceive a 
nearer resemblance to an anatomical preparation de- 
signed to show the veins, than the hand of this patient, 
yet when relieved by proper nervous stimulants, or 



48 THE SPHYGMOGBAPH. 

otherwise, they were not different from those of other 
emaciated people. 

The radial arteries gave no indication to the touch 
of calcareous degeneration, nor indeed is it likely that 
such existed. 

The seventh is the record of a young lady twenty- 
three years of age, suffering from aortic valvular dis- 
ease. The general flatness of the wave, which has 
already been alluded to as a subject of some difference 
of opinion, the distinction between the first and second 
event and the prominence of the latter, as in the case 
of Mrs. Y. (see above, example 5), are the only points 
of interest. The tension, as indicated by the degree 
of pressure requisite, is greater than in any of the 
preceding, and indicates a prolongation of effort of 
the heart to overcome some obstruction. 

The eighth is the tracing of a young man, suffering 
from serious valvular disease. The affection followed 
acute articular rheumatism, and in many of its circum- 
stances is a case of particular interest. So far as our 
present purpose is concerned, however, it is presented 
merely as an illustration of a peculiar form of systolic 
wave. The other features of the tracing will be ex- 
plained in their appropriate place. 

The ninth is a tracing taken over a subclavian 
aneurism, which subsequently burst, and in which a 
post mortem examination was made. The systolic 



THE SPHYGMOGRAPH. 49 

wave is evident in each apex of the writing, varying in 
each to a remarkable degree. The abrupt termination 
of the wave, as shown by the sharp angle which deter- 
mines the commencement of the collapse, indicates the 
absolute want of elasticity of the vessel, and for the 
present is the point of chief interest. 

The tenth exhibits the marked preponderance of 
the first above the second event, in a young lady 
with aortic obstruction and regurgitation. The high 
pressure required upon the artery is a feature of 
interest. 

The eleventh gives probably the smallest systolic 
wave obtainable as a distinct event, and contrasts 
remarkably with the preceding. It is the record of a 
young man during slow convalescence from a pericar- 
ditis with endocardial complication and subsequent 
hypertrophy. 

The twelfth was taken from the same person on 
another occasion. This remarkable tracing may be 
open to more than one interpretation, and it is not 
improbable that I may be mistaken in translating it, 
simply as an exhibit of the two events we have been 
studying. 

If I am right, the systolic wave is deferred consider- 
ably beyond the usual time, and the artery once filled 
remains so till after the heart has again begun to con- 
tract. The only other cases in which I have observed 



50 THE SPHYGMOGEAPH. 

this peculiarity have been two, a victim of senile gan- 
grene, and another, a case of advanced phthisis. 

This event may have the following variety of signi- 
fication : 

1st. It shows the manner in which the chief function 
of the heart, that of supplying the blood to the arte- 
ries, is performed, whether as to force, duration of 
propulsive effort or method of cessation. 

2d. The condition of the capillaries may by it be to 
a great extent determined, especially with reference to 
their contractility, as may be seen by reference to the 
changes grown out of sympathetic disorder or degene- 
ration of their tissues. 

1st corollary. The condition of the nerve supply to 
the heart, and the possible influence of cerebral disor- 
ders upon its action, may be to some extent ascertained. 
2d corollary. It will, in most instances, determine 
the volume of blood delivered at each cardiac systole. 
3d corollary. It may enable us to decide upon the 
condition of the mitral or aortic valves. 

The next feature of a sphygmographic tracing is one 
that naturally follows the one just considered, for as 
that was a wave due to the filling of the vessel, this 
would show its emptying or collapse. As it is of 
course synchronous with the cessation of the filling 
force and the diastole of the heart, it has generally 
been termed the diastolic collapse or third event. 



THE SPHYGMOGBAPH. 51 

The third event. 

This, as already said, is but the evidence of what 
occurs in the artery after the distending or filling power 
is removed. A moment' s reflection will show that as 
the arteries are for all practical purposes open only at 
one end, i. e. toward the capillaries, it is through them 
that the contained blood must find escape. If it does 
so, other things being equal, the wave of distension, 
i. e. the systolic wave or second event of the writing 
would subside suddenly or slowly, in direct ratio to 
the freedom of exit ; but, as one may easily imagine 
an artery only partly full and without any means of 
escape for its contained blood, in which a propelled 
influx would produce distension and subsequent col- 
lapse due to a retirement of the wave, it is evident 
that the collapse may not always be a simple or easily 
explained event. Such is the case, and the variations 
in this part of a tracing are therefore of considerable 
importance. 

It has been suggested that the period occupied by 
this collapse of the artery is significant, because the 
measure of duration of the contraction of the heart ; 
but that this can hardly be the case, would appear 
from several facts, viz. , that although when the heart' s 
contraction ceases, the propulsion in the aorta also 
ceases almost simultaneously, yet such cannot be true 
of the remote arteries, and at the instant of cessation 



52 THE SPHYGMOGEAPH. 

of current at the sigmoid orifice, there is still an 
onward movement in them. 

It is true, that this condition must be of brief dura- 
tion, but as fractions of seconds would be of value in 
estimating the actual duration of contraction in an 
organ whose evolution often occurs twice in a second, 
this feature of the tracing could hardly be relied upon 
as an index of it. 

Further than this, there may and often will occur in 
a writing what I have elsewhere alluded to as between 
the third and fourth event, viz., a wave probably of 
recoil. This may be noticed in the tracing marked 
four, "on the chart illustrating the systolic wave or 
second event. Its significance will be weighed in con- 
nection with the fourth event, yet to be explained. 

For the present purpose, it is only necessary to say 
that as this occurs during and before the actual cessa- 
tion of the collapse of the artery, it must interfere with 
our deciding the instant of such cessation. 

For examples of this event in a tracing, reference 
may be had to the chart above alluded to, illustrative 
of the systolic wave. 

The slow and even emptying of the artery is seen in 
example No. 6. 

The sudden collapse in Nos. 8 and 11. 

The abrupt yet confused collapse in No. 9. 

The failure of the event in No. 12. 



THE SPHTGMOGRAPH. . 53 

That of the first case was due to a weak heart, but 
pervious though probably inelastic capillaries. With 
an excited or hypertrophied heart, this impairment of 
capillaries would have effectually prevented so even a 
collapse. Those of the second cases (Nos. 8 and 11) 
were due to aortic regurgitation. 

Of the third (No. 9) to aneurism. 

Of the fourth (No. 12) to commencing hypertrophy 
with excitement. 

The chief significance to be attached to the third 
event is probably as follows : 

1st. By it we may determine the manner of subsi- 
dence of the propelling power, such as would arise 
from dilated or weakened heart, or regurgitation of 
the blood back into the heart, whether from the aorta 
into the ventricle or from the ventricle into the auricle. 
Aside from the assistance to be obtained from other 
parts of the tracing, the existence of eccentric, as dis- 
tinct from concentric, hypertrophy might be proxi- 
mately determined. 

2d. By it, also, information may be gained as to the 
manner of exit of the blood from the arteries into the 
capillaries, a matter the importance of which is closely 
allied to the condition of arterial or venous tension, 
and valuable from a physiological point of view, as of 
assistance in estimating the character of nerve supply 
and the action of remedies. 



CHAPTER V. 

The fourth event. 

This lias been variously styled the diastolic expan- 
sion, the dicrotous wave, the wave of recoil and the 
recurrent or reflex wave. In a hypothetical tracing it 
could be represented as follows, letter C. 



As this wave is a feature often of importance, and 
has been the subject of much discussion, any new facts 
elicited by a new instrument may serve to settle its 
trne significance. 

Naumann and Marey have supposed it a recoil of 
the blood current, due to a rebound against the closed 
aortic valves. 

Many experiments made by Sanderson have dis- 
proved this theory, and a reference to the fourth tracing 
on the chart, opposite page 45, affords confirmatory 
evidence. Experiments made by myself also with an 
artificial heart, and elsewhere published, seem to ren- 
der such an explanation untenable. As intimated on 
the preceding page, the tracing just alluded to shows 
that the wave of recoil correctly inferred to exist by 
Nanmann and Marey, comes when at all, before the 



THE SPHYGMOGKAPH. 55 

collapse, and not after, and is probably almost syn- 
chronous with the closure of the valves. 

The true diastolic expansion occurs subsequently. 

Omitting further allusion to the opinion of others, I 
may be pardoned the attempt to explain the wave by 
reference to my own observations, but before offering 
such explanation would present examples of the event 
under varying circumstances. 

The first (see chart of 4th event) is the case of a man 
under treatment for persistent vertigo, of full habit, 
robust and broad-shouldered, but with the red vessels 
apparent on the cheeks, and the peculiar appearance 
suggestive of apoplexy without any other actual or 
well-marked signs of it. For the present purpose, it 
is sufficient to say, that the general capillary circula- 
tion, of the integument at least, had never been 
impaired. Critical examination of the heart indicated 
disease of the aortic valves. The tracing shows marked 
shock-wave, sudden collapse of the artery, and conse- 
quently either the rapid escape of the blood through 
the capillaries, as if by their dilatation, or a limited 
supply of blood at each pulsation. 

In this case the slip of paper was moving slower 
than usual. The influence of this variation in an 
instrument will be hereafter considered. 

The second is that of a young female suffering from 
hypertrophy and aortic obstruction, with possibly 



56 THE SPHTGMOGEAPH. 

aneurism of the arch of the aorta. The most sug- 
gestive evidence of the latter seemed to be a marked 
thrill communicated to the hand when placed on any 
part of the thorax. 

The slow filling of the artery as indicated by the flat- 
tened apex of the systolic wave, the somewhat sudden 
diastolic collapse, and the irregularity of the tracing, 
suggest a failure of the heart to propel a great amount 
of blood, such as would be the case, for example, in 
mitral insufficiency, where a portion of the blood is 
forced back with each systole into the auricle. The 
tension is somewhat greater than the preceding, and 
the dicrotic wave not remarkably prominent. The case 
itself will be elsewhere considered. 

The third is the tracing of a young man, age twenty- 
six, with but one arm, amputation having occurred at 
puberty after an accident. The patient had generally 
been known as a healthy, hard-working man, but at 
the time of observation was somewhat debilitated from 
over- work and anxiety. A peculiar murmur could be 
heard over the pulmonary valves, but no distinct 
evidence of organic disease was discoverable. The 
indications of the tracing seem to be such as would 
arise from impaired action of the heart due to simple 
debility. The skin was moist and soft, the muscles 
flabby, and the integumentary circulation atonic. The 
patient has since recovered. 



THE SPHYGMOGKAPH. 57 

The fourtli is the record of a man supposed to be 
sound, age forty, and accustomed to much travel and 
out door exercise. When thus engaged he is appa- 
rently vigorous, with exception of a chronic pharyn- 
gitis, but a few weeks confinement at office-work pro- 
duces languor, cough and debility. Eight or ten years 
since he raised considerable blood, probably from the 
lungs. A rigid examination gave no positive evidences 
of thoracic disease at the time of the observation. 

Dicrotism is not well marked, and might possibly 
be deemed absent but for the presence of the first and 
second event combined in the first wave. The collapse 
of the artery follows, and the next ascent is therefore 
truly dicrotous. Here also there appears atony, either 
of the heart or arteries. 

The fifth and sixth are both from patients weak- 
ened by disease ; the first a female with consolidation 
at the apex of one lung, occasional haemoptysis and 
progressive debility ; the other a man age sixty, much 
worn by the exhausting discharges and general irrita- 
tion produced by a sloughing foot, probably a case of 
senile gangrene. 

The seventh is a singular tracing for a person free, 
to all ordinary means of observation, from organic 
disease, but debilitated somewhat by excessive use of 
tobacco. 

The eighth is from a man of fifty, during the pros- 



58 THE SPHYGMOGKAPH. 

tration of a low form of delirium tremens — healthy so 
far as known. 

The ninth is common in phthisis, and in this case 
was the record of a young man rapidly growing worse 
and with extensive cavities. 

The tenth exhibits very plainly the wave we are con- 
sidering. It is the tracing of a young lady, age twenty- 
eight, much debilitated by prolonged mental work, 
the entertainment of company, and the cares of a large 
household. This patient has phlebectasis laryngea 
and hypertrophy with aortic regurgitation. 

The eleventh is the case of a young gentleman with 
cardiac disease and^debility, similar to. the preceding. 

Other examples of the dicrotous wave, or fourth 
event, will be found in a subsequent part of this 
work. 

In summing up the examples given, one feature pre- 
dominates, namely, a condition of atony either of the 
capillaries or the heart. We may, therefore, enquire 
whether this be the cause, and to what extent the phe- 
nomenon is explainable in our experience. 

Two especial conditions are alluded to by Professor 
Sanderson in his work (p. 64), as giving rise to this 
wave, viz., a smaller quantity of blood than normal 
discharged by the heart into the aorta, and conse- 
quently a less quantity to be disposed of by the capil- 
laries ; and second, a dilatation of the capillaries by 



THE SPHYGMOGRAPH. 59 

which a normal quantity may be just as readily passed 
through them. 

Experiments with the artificial heart, which need 
not be given in detail, show conclusively that freeness 
and not constriction of capillary circulation favors 
dicrotism. The explanation of this phenomenon, 
which at first seems at variance with what we should 
expect, may be seen if we analyse the method of trans- 
mission of blood from the heart through the tortuous 
capillaries to the veins. As already said, when the 
onward movement ceases in the aorta and large vessels 
it is still evident in the remote and smaller ; the cessa- 
tion, beginning at the heart, travels quickly toward 
the periphery. During the most violent portion of 
the propulsive effort of the heart, the onward move- 
ment may be almost uniform throughout the calibre of 
any given remote artery, as, for example, the radial ; 
but as this diminishes, the slowing of the current must 
appear in the part of it nearest the coats of the vessel, 
according to a well-known philosophical law ; the best 
exemplification of which is seen in a running stream. 
In this, the water nearest the shore moves perceptibly 
slower than in the center, owing to the friction. In 
a tube of small dimension another principle is intro- 
duced, viz., that known as capillary attraction. In 
both cases, however, the same thing is true ; the central 
part of the current is the last to fail and cease. 



60 THE SPHYGMOGKAPH. 

These two philosophical facts seem to explain in 
every particular the phenomenon of diorotism. Under 
all circumstances, except those of such rigidity of 
arterial coats as to resist slight impressions, the con- 
dition might be educed. Careful adjustment of the 
instrument shows this to be true. If the arterial tissues 
were in a state of atonic relaxation, the wave would be 
increased. This also is true, for the condition has been 
heretofore best known in connection with adynamic 
fever. Were the amount of blood thrown into the 
aorta small, an event usually accompanied by relax- 
ation of the elastic and contractile tissues of the body, 
the wave would be quite prominent. This, also, is 
true. 

I am not aware that this explanation has ever been 
offered except, elsewhere, by myself ; but as it appears 
to be consonant with practical experience with the 
instrument, and in no ways at variance with the expe- 
rience of other observers, it has appeared to me the 
correct one. 

In this connection it may be interesting to ascertain 
whether the deduction of Prof. Sanderson, that ' ' dicro- 
tism is characteristic of that condition of the circulation 
in which the arterial pressure is diminished while the 
venous is increased," is generally a correct one. 

1st, Tracing (No. 163) was taken from a person in 
whom the venous engorgement was excessive, and 



THE SPHYGMOGKAPH. 61 

which was evidenced by exacerbation of weakness, and 
of all the unpleasant symptoms occasional during her 
previous illness ; so great, moreover, that the super- 
ficial veins were singularly prominent, even painfully 
so, and yet the chief feature in all the tracings taken 
was, as in the one given, the absence of dicrotism. 
Three days later the venous engorgement had subsided 
and the arterial pressure had increased, dicrotism being 
faintly evident. 

2d, Case (No. 70 to 73 — see chart) shows a precisely 
opposite condition. The patient whenever exposed to 
cold has attacks of vertigo, dyspnoea and faintness. 
At such times the veins, wherever within reach of 
touch or sight, are found flaccid and almost empty. 
The arterial pressure is very great, as will be seen by 
the degrees marked upon the tracings, and dicrotism 
is well marked. On other occasions when the equilib- 
rium of pressure in the venous and arterial systems is 
more nearly maintained, the dicrotic wave is reduced 
or absent. 

These two examples have been taken at random, and 
show that the deduction quoted cannot be universally 
true. They do not, however, militate against the 
explanation of the wave as given above ; and one 
additional and important fact may be added to this 
explanation as corroborative, viz., that it explains the 
well-known connection between dicrotism and hemor- 



62 THE SPHTGMOGEAPH. 

rhage, of which in typhous fever it is so often the 
precursor. 

The significance of the fourth event may therefore be 
set down as indicating chiefly — -1st, a condition of 
atony of the arterial tissues, particularly of the capil- 
laries, as evinced in the dicrotism of adynamic fevers ; 
of debility from impairment in vigor of the heart, and 
of reactionary debility, as after delirium tremens. 
In all of these it is not improbable that the deficient 
tonicity is due to the condition of the inhibitory nerves. 
The dicrotism of epilepsy, an example of which will 
be found in a later part of this Essay, and to which 
attention was probably first called by M. Voisin in the 
Biennial Retrospect of the Sydenham Society, 1867-8, 
p. 471, would form in this connection the subject of an 
interesting essay, so also that of asthma, vertigo, sun- 
stroke, etc. , as seen upon the charts appended. 

2d, From the very nature of the above essential pe- 
culiarity, it may be of value as a ground for prognosis 
when occurring during the progress of any wasting 
disease. 

Before leaving the subject of the fourth event of a 
tracing — the dicrotous wave — it may be in place to 
observe that the term has given rise to some confusion, 
because not literally expressing its actual meaning. 
Derived from &v and Kuoriu, and meaning " I strike 
twice," it has conveyed to many casual readers the 



THE SPHYGMOGRAPH. 63 

impression that any break in the smooth, even wave 
of robnst health is an evidence of dicrotism. From 
what has been said concerning it, this will be seen to 
fall wide of its proper meaning. Tracings are, in a 
literal sense, frequently tricrotous ; but for purposes of 
Sphygmographic interpretation, not so, correctly speak- 
ing. The words tricrotic and dicrotic, as similarly 
derived, should be held as having similar meaning, 
and this meaning was settled before the invention of 
the Sphygmograph. 

The double beat perceptible to the touch of the older 
physicians could arise only from the occurrence of a 
second impulse, late enough to fall just prior to a new 
systolic wave, and quite subsequent to the diastolic 
collapse. 

Whatever, therefore, may be the number of waves 
preceding the collapse of the artery, they cannot be 
termed dicrotic ; the meaning of the term, as established 
years ago, should and does retain its old significance. 



CHAPTER VI. 

GENERAL PROPERTIES OBSERVABLE BY THE SPHYGMOGRAFH. 
COMPRESSIBILITY, OSCILLATION, LOCOMOTION AND RECOIL. 

Many of the general properties of arteries and the 
circulation have been incidentally considered during 
the above remarks. There are, however, some of 
greater or less importance, deserving especial mention, 
viz: Compressibility (or tension), recoil, and oscilla- 
tion of the circulating fluid ; and of the arteries as 
purely mechanical contrivances, locomotion. 

Of the latter quality, which is properly but an ana- 
tomical peculiarity, little need be said, save that as it 
is sometimes excessive, it may communicate a vibra- 
tory character to a tracing, sufficient to be mistaken 
for true oscillation of the blood current itself, or cause 
vexatious delay in obtaining a proper record. The 
property of locomotion grows naturally out of the 
elastic character of the arterial tissues, and is simply 
that displacement of the vessel often observable in old 
persons, whose emaciation renders the arteries quite 
superficial, or in any one, when under sufficient excite- 
ment to cause an unusual volume of blood to be forced 
into the arteries by the heart. 
In the former case, the fact that all arteries elongate 



THE SPHYGM0GRAPH. 65 

under the pressure of the blood, as well as expand 
laterally, is quite evident to the eye, and it is probable 
that the locomotion is much exaggerated by the im- 
pairment of natural elastic resistance due to age. 

In the latter case, it will be usually found accom- 
panying great arterial fullness. 

It is easy to perceive how any excess of this quality 
should exhibit itself in a tracing. Generally, however, 
the groove in the pulse- spring already described, by 
fixing the vessel against lateral motion, prevents the 
marring of the record, and the regulation of the 
pressure- spring utilizes the quality to increase the 
amplitude of the tracing. 

The chief pathological significance of locomotion is 
probably in connection with cases of aortic regurgita- 
tion, as remarked by Dr. Corrigan. 

Oscillation or Vibration. 

This quality of the circulatory blood is an important 
one in connection with the translation of a Sphygmo- 
graphic tracing. It is to be carefully distinguished 
from the waviness of line caused by muscular or ten- 
dinous tremor, which is of itself an interesting feature. 
It may be the best described by a simple illustration : 

When a rubber tube of small calibre is attached tc 
the ordinary house supply pipe, from the hydrant, the 
current produces to the touch no appreciable thrill; 



66 THE SPHYGMOGRAPH. 

but when compressed slightly between the point of 
observation and supply, a peculiar vibration is com- - 
municated, often to such extent as to be accompanied 
by a low musical note. This vibration is most evident 
at the point of pressure, and diminishes as we recede 
toward the open extremity. Partially close the ex- 
tremity, as by the division into smaller and branching 
capillaries, and the thrill is still better transmitted. 
Now apply the pressure more remotely, and examine 
in the opposite direction, no thrill or vibration is com- 
municated in this direction, i. <?., toward the supply, 
until the pressure is made, however slightly, intermit- 
tent. 

It is then well or ill defined, just in proportion to 
the amount of pressure and duration of intermission. 
The fullness of the tube at the time seems to exercise 
but little influence in the latter case, but considerable 
in the former. 

Apply, now, this fact to the arterial system. The 
pressure of enlarged bronchial or axillary glands, or 
the simple twist of the fore-arm, which as is well 
known may be dexterously made to obliterate pulsa- 
tion at the wrist, will sometimes communicate an os- 
cillatory character to the tracing. As may be inferred, 
this would be slight or well defined, just in proportion 
to the amount of pressure and the fullness of the 
artery. 



THE SPHYGMOGEAPH. 67 

On the other hand, suppose a condition of the nerv- 
ous system, such as is common in many cases, but, 
perhaps, most familiar in hysterical females, in which 
the capillary circulation is influenced by inhibitory 
nervous action. This action may be to such an extent 
intermittent as to exhibit itself in an oscillatory thrill 
in arteries of small calibre, precisely as in case of the 
intermittent distal pressure in the artificial capillaries. 
Examples of this are most frequent in blood poison- 
ing by mercury, or Bright' s disease, in asthma, in 
epilepsy, etc. 

Another cause of oscillation of the blood in the 
arteries, may be the familiar one of aneurism. In the 
cases of this disease so far advanced or of such char- 
acter as to cause a perceptible thrill to the touch, when 
applied to a neighboring artery, the waviness of the 
Sphygmographic line is peculiarly marked. Even in 
many instances, where a remote or contiguous artery 
appears free from any tremor under the finger, this 
feature is brought to light and recorded by the instru- 
ment. 

Another cause of oscillation may be the direct press- 
ure of the instrument in certain conditions of tension 
of the arteries. This is a fact observable with the 
single rubber tube already described. When this was 
made tense by an increase of water beyond the power 
of the tube to deliver readily, a very slight pressure 



68 THE SPHYGMOGKAPH. 

sufficed to produce a considerable thrill. When, how- 
ever, the amount of tension was reduced by reducing 
the supply, a great pressure was found necessary to 
develop it. The deduction from these facts seems to 
be, that the vibration may be an index of tension. 
And such it may really be in the human system ; for 
an artery is in many respects analogous to the tube 
described. There are, however, so many modifying 
circumstances in the one case that do not exist in 
the other, that the rule is by no means safely applica- 
ble. For example, there are cases on the charts, as 
carefully observed as possible, in which a pressure of 
100 grammes (0°) permitted the exhibition of oscilla- 
tion which disappeared at 300 grammes, and reap- 
peared at 600. The very fact that so high a pressure 
gave any tracing was prima facie evidence of great 
arterial tension ; but the disappearance of the phenom- 
enon at the intermediate pressure it is difficult to un- 
derstand. Another example, however, is explainable 
upon the principle described. Thus, when experi- 
menting upon the action of medicines on a healthy 
pulse, 100 grammes (0°) gave a smooth even tracing, 
without vibratile, character ; 186 grammes (2£° or 2880 
grains) developed the oscillatory waves to a marked 
extent, while greater pressure failed to give any tracing. 
The inference, and a correct one in accordance with the 
law observed with the tube, is simply that the actual 



THE SPHYGMOGRAPH. 69 

tension of the artery was slight ; the precise deduction 
being that 2|° was above a proper register. 

Another source of oscillation may be the existence 
of a partially detached valve at the aortic orifice. A 
singular example of this was presented to the Essex 
County Medical Society of New Jersey, by Dr. Whit- 
tingham, a year since (1871). The patient, a negro of 
middle age, had for about a year been under observa- 
tion on account of a peculiar thrill observable on all 
parts of the body, but especially over the base of the 
heart, and of considerable intensity in all the super- 
ficial arteries. To the ear, the thrill became a low, 
almost continuous musical note ; to the touch, it was 
suggestive of the vibration of a guitar string. A post 
mortem examination verified the diagnosis above 
given. 

Beyond the causes of oscillation already given, it 
appears not improbable that another may occur from 
the character of the heart-beat, as in hypertrophy ; for 
a condition in which the beating of the heart and even 
of the arteries is plainly perceived by the patient, is a 
familiar one, and in view of the fact that a slight blow 
upon a filled elastic tube communicates a thrill to its 
contents, such a character of the heart beat might pro- 
duce a similar thrill in its attached arteries. 

The existence of such a cause, however, would be 
easily ascertained by other means. 



70 THE SPHTGMOGEAPH. 

Finally, it should not be forgotten that an apparent 
oscillation may arise from muscular or tendinous 
tremor — examples of which may be seen in the chart 
on the opposite page. 

The first, is a record from a lady, just past the 
prime of life, suffering from a fibroid tumor of the 
pharynx, and having a subclavian aneurism of thirty 
years' standing, formerly a source of annoyance, and 
under the treatment of Dr. Mott of New York, but 
long since quiescent. The tracing is from the radial 
artery of the same side. The patient was perfectly free 
from any apparent nervous tremor or excitement, as 
indeed is evident in the slowness of the pulse. No 
other evidence of aneurismal thrill was obtainable, 
and the swelling, slightly prominent above the clavicle, 
was dense and unyielding, probably owing to nature' s 
restorative efforts.* 

Tlie second, is from a patient twenty-four hours after 
a profuse uterine hemorrhage, following confinement. 
The tension, under the circumstances, is remarkable, 
but is probably due to the failure of the artery to 
collapse, as will be seen in the prolonged systolic 
wave. 

The third is the record of an old man, just after 
amputation of the thigh at the middle third, for disease, 



* Note. — Autopsy has since shown this supposed aneurism to have been an 
exostosis on the first rib, pressing upward the subclavian artery. 



THE SPHYGMOGRAPH. 71 

and exhibits simply an oscillation dne to nervons 
shock. 

The fourth and fifth are placed in apposition be- 
cause similar and yet dissimilar. The first is not the 
correct record of the artery as regards tension, because 
a pressure of 5° exhibited a condition of disease of the 
heart and its valves, at which pressure the oscillation 
ceased. The arterial tension was indeed great at the 
time of the observation. 

The oscillation is slight, and the tracing would more 
properly come under the head of "recoil," that wave 
being evident in it, but that it offers so excellent an 
opportunity to compare that which follows. 

This is the record of a healthy man, under the influ- 
ence of Gelseminum, taken for experiment (aet. 32), 
and the very slight oscillation is probably due to some 
perversion of nerve influence in the arterial coats. 

This example illustrates forcibly the necessity for 
regulating and observing a proper pressure in order to 
obtain a correct record. 

The sixth, seventh, eighth, and ninth appear to be 
due also to some perversion of nervous vitality, and 
possibly are connected with the inhibitory function. 
They are (in order) those of a man of forty-five, other- 
wise sound, but the victim of the abuse of tobacco ; 



72 THE SPHYGMOGKAPH. 

of a younger man similarly disordered ; of a man 
convalescent from delirium tremens (the arterial ten- 
sion in this case was considerable) ; and of a man with 
suffocative bronchitis. The last two were of middle 
age (40-45). In the latter the oscillatory character 
was greater at 4° than at 0°, as given, but exhibited 
other features, marring it for this illustration. At 2|° 
the oscillation was absent, and this pressure was pro- 
bably the correct register of arterial tension. 

The tenth is from a delicate, hard-working female, 
debilitated by exhausting and prolonged labor. Vi- 
bration disappeared under a pressure of only 1|°, as 
in fact did the pulse itself. It is the irregular tremor 
accompanying debility, and may possibly be only the 
result of tendinous motion. 

In reviewing the above cases, the fact that appears 
most indicated, seems to be that to some deranged 
nervous force is to be attributed the phenomenon of 
oscillation. It is, for example, marked in all cases of 
progresso loco-moto-ataxia, and is best illustrated in 
Bright' s disease, delirium tremens, asthma, and the 
shock subsequent to amputation. 

Its significance as a feature of a tracing may be thus 
summed up : 
Aneurism ; 
Distorted inhibitory function ; 



THE SPHYGMOGRAPH. 73 

Severe disorder of tlie cerebrospinal system ; 
Compression of the artery between the point of 

observation and the heart; 
Compression by the instrument itself ; 
Blood poisoning, as in Bright' s disease, or from 
medicines. 
It may be the measure of tension, and is the mea- 
sure of pressure as an index of tension. It may be 
due to a detached naive or other movable body in the 
large arteries. It may be simply apparent and due 
to muscular or tendinous tremor. 



CHAPTER VII. 
RECOIL. 

There will often be observed in a tracing a wave 
following the second event, always prior to the true 
diastolic collapse, and with or without the diastolic 
expansion, and distinguishable from the latter by 
its precedence of the emptying of the artery. It is 
not improbable that this wave, which seems not to 
have been before noticed except to be confounded 
with the diastolic expansion, might be developed by 
very patient adjustment of pressure upon the artery 
in a majority of instances. 

As it seems to be more truly synchronous with the 
closure of the semilunar valves than can be the begin- 
ning of the collapse of the radial artery at least, 
which as occurring more remote from the heart must 
be a slightly later event, it may be interesting to 
inquire into its significance. In a hypothetical tracing 
it could be represented thus— D : 

D 





Examples of this wave may be seen in the records 
of the action of medicine upon the healthy pulse, as 



THE SPHYGMOGEAPH. 75 

in the case of Cannabis Indica or of Grelseminum. (See 
Part III. of this Essay.) 

If in the subsequent remarks there may appear an 
assumption of certainty with regard to this wave and 
its cause, not fully warranted by the tracings adduced, 
it may be of interest to present here, testimony singu- 
larly corroborative of it. 

In the London Lancet of November 10, 1866, there 
appeared the record of some experiments, made, I 
think, by Dr. Anstie, upon the difference between the 
pulse (as observed with a sphygmograph) of the caro- 
tid and radial arteries. A fac-simile of the tracings — 
upon the former — has . been preserved and is given 
below. 



Tracing of the carotid of a man tvilh no organic disease, 
convalescent from lead colic. 



By this appears what would naturally be inferred, 
if our premises are correct, from the proximity of the 
vessel to the heart — a sliock toave, a swiftly-following 
wave of filling, or true systolic wave, and then, as the 
artery begins to empty itself of the first rush of blood, 
a second slioclc-impulse, synchronous with the closure 
of the valves. 



76 THE SPHYGMOGRAPH. 

In the radial also, it is not a difficult matter to see 
why such a recoil of blood should occur at such a 
time, or rather why an apparent recoil should appear, 
for, inasmuch as we have seen that the first event of a 
tracing is frequently a wave due to transmitted shock 
(the shock consonant with the bursting open of the 
aortic valves), we should naturally expect in certain 
conditions of the circulation that the closure of the 
valves with a shock almost equally sudden would 
produce a like result. 

In fact, but for the difference in intensity of the two 
events, the latter would be more certain to produce it, 
for a more dense conducting medium has been created, 
and the direction of transmission is with the current. 
It is moreover just at the point indicated that we 
should search for it, viz., just before the collapse, 
which begins in the larger artery, has been transmitted 
to the smaller or peripheral. It is not improbable 
that in the tracings illustrative of oscillation I may 
have included some having this wave of recoil. ISTos. 
4 and 5 are open to this suspicion. 

The chief significance of this wave seems to be, first, 
arterial tension (the more full the arteries the better 
it is developed) not due to any organic disease. The 
best examples of this will be found in tracings Nos. 
25, 26 and 28, Part II. 

When connected with organic disease as of the aortic 



THE SPHYGMOGEAPH. 77 

valves, in which their free falling back against the 
arterial wall is prevented, there wonld of necessity be 
less arterial tension, and if no regurgitation existed, 
the tracing, with this one exception of pressure 
required, would be very similar. This is exemplified 
in the tracings Nos. 62 and 63. In these it is interest- 
ing to note how the flattened top of the conjoined first 
and second waves exhibits the slow delivery of blood 
by the heart, as if contracting against obstruction ; 
and also the similarity in other particulars to a healthy 
record. The patient was a young female with aortic 
valvular stenosis. 

Second — A condition analogous to that which devel- 
opes the most fully the first event or initiative wave of 
the tracing. This, as we have seen, is an increase of 
nervous vigor of the heart, perhaps better expressed 
by the word hyperesthesia, and generally temporary 
in character. That there is a true nervous element 
exhibited by it is apparent from the cases in which it 
occurs, viz., asthma, hysteria, functional cardiac dis- 
ease, and those showing the influence of Gelseminum, 
Aconite or Quinine, etc. Cannabis Indica produces it 
only when given in moderate doses. 

It is probably safe to say, that it may be generally 
predicated of a sound organic condition when occur- 
ring with a marked "first event" in a tracing other- 
wise good. 



78 THE SPHYGMOGRAPH. 

Third — It is corroborative evidence of obstruction at 
the aortic orifice when occurring in a tracing with con- 
joined first and second wave, or in which a flattened 
wave, caused by the union of these two, drops with a 
perceptible angle. Alioays excepting cases of liigli 
arterial tension. Examples of these will be found in 
Part II. of this work. 

One remark seems necessary, in addition, with 
regard to the occurrence of this wave as in any way 
the measure of tension. It has been said above, that 
it seems connected with a condition of tension only in 
health, or at least when no cardiac disease exists ; and 
that occurring with a low arterial pressure it seems to 
indicate disease. Why the wave, if it be a true trans- 
mitted shock-wave, should be transmitted at one time 
by a full artery and again by one but partly filled, 
may seem paradoxical, in view of the assertion that 
fullness is essential to its production. The explanation 
however probably is, that in health a state of tension 
is requisite to allow a sufficiently dense conducting 
medium from the point of observation to the heart, 
but when a prolonged effort of the heart is rendered 
necessary by disease a more continuous and even 
fullness exists short of actual distension. This is 
evidenced by the fact that in the latter case the press- 
ure is generally from 2%° to 3£°, whereas 4° or 5° are 
necessary in the former. 



CHAPTER VIII. 



COMPRESSIBILITY OR TENSION. 



Thus far allusions to tension have always been to 
arterial fullness as compared with that of the veins ; 
and naturally the measure of this fullness has been 
ascertained by the compressibility of any artery of 
moderate size. We have seen that under some circum- 
stances there may be other means of ascertaining the 
same fact, but the best and most reliable is certainly 
the ability of the artery to bear pressure without oblit- 
eration. All observers have felt the need of some 
means, not only of readily bringing proper pressure 
to bear upon the artery, but of instantaneously and 
accurately recording it, and a glance at the charts 
presented will show how necessary this must be to any 
reliable record. In many cases of known disease of 
some important organ, a pressure such as has gene- 
rally been used with Marey's instrument, has given 
the smooth even tracing of vigorous health, but a turn 
of the coiled pressure spring has brought out the evi- 
dences of serious disorder. 

This may be true of even a dangerous cardiac 
disease, and therefore, no accumulation of records 
without this would be of practical value. 



80 THE SPHYGMOGRAPH. 

It is indeed often desirable or even essential to repeat 
observations with the same pressure, and to depend 
upon the other means indicated in the preceding re- 
marks, to determine the fullness of the arteries, as in 
the recorded experiments upon the action of certain 
remedies ; for valuable time would be wasted in taking 
several tracings at the very short intervals allowed, but 
in examining the same persons on different occasions, 
tracings should be taken at various degrees of press- 
ure in order to be positive as to the correct record ; 
for, in most instances, the highest degree which the 
artery will bear without obliteration is by no means 
the measure of tension, nor may it give the tracing of 
greatest amplitude. Generally, the amplitude in- 
creases up to a certain point, and then gradually 
lessens with increase of pressure. This point is un- 
doubtedly the correct one at which to complete the 
observation at the sitting. From this it is evident that 
single tracings are not rightly comparable. Groups 
are requisite, and the reader may thereby be enabled 
to draw a correct deduction. 

The importance of ascertaining the compressibility 
of the artery as a means of arriving at a correct tracing 
is self-evident ; but as an independent quality of great 
significance, and as one having a meaning apart from 
the waves of the Sphygmographic record, it deserves 
especial mention. 



THE SPHYGMOGRAPH. 81 

It often appears impossible to press upon the radial 
artery with the finger with sufficient force prevent its 
pulsation. Even when this seems to be accomplished, 
at the point of pressure it may be seen pulsating a 
little below, and it is evident, therefore, that the pro- 
pulsive power with which the blood is driven into the 
capillaries may be enormous. As this point has been 
satisfactorily studied by the eminent physiologists of 
the present day, it is doubtless too familiar to bear 
discussion, but the degree to which it may vary under 
different circumstances, is of great pathological im- 
portance, and comes within the sphere of Sphygmo- 
graphic observation. 

By the amount of tension of the arteries, or, to 
express it more clearly, by the extent of accumulation 
of blood in them, we may infer the amount in the veins, 
the conducting power of the capillaries, and the con- 
dition of the heart. 

From these three, as starting points, a wide range of 
physiological and pathological conditions may be de- 
cided. If we recall, for a moment, the experiments of 
Dalton upon the sympathetic nerves, their influence 
upon vascularity and nutrition, when divided or sub- 
jected to galvanization, or their connection with the 
cerebrospinal system ; and the patient investigations 
of Bernard into their influence over the phenomena of 
organic life ; or consider the intimate relations between 



82 THE SPHYGMOGRAPH. 

the nervous and vascular tissues throughout the body, 
the effect of digestion, of exercise, of fatigue, of stimu- 
lants, of medicines, of temperature, or of emotion, 
upon the blood in arteries or veins ; or think of the 
heart enfeebled by disease vainly striving to maintain 
the equilibrium of pressure so essential to health, 
we realize the importance of the quality we call 
tension. 

When the familiar examples of contracted capilla- 
ries, as from severe cold or the influence of sudden 
fright, present themselves, we fail perhaps to think of 
the over-burdened arteries that are unable to rid them- 
selves of the accumulating blood ; but in cardiac 
disease so serious as to make the accumulation a new 
burden to the already over-taxed heart, these minor 
conditions attain a vital significance. 

In such cases, the question as to whether the maxi- 
mum of pressure shall be in veins or arteries, touches 
the life of the individual. 

In cerebral diseases, in congestive or inflammatory 
stasis in different organs, in the damage done by dram- 
drinking, in the relapses that occur during convales- 
cence from certain fevers, where the change in the 
capillaries is the first sign of change in their nerve 
supply, and the evidence of this in the compressibility 
of the arteries, is to us the warning of relapse ; and in 
degeneration of the tissues of the arteries, where, as 



THE SPHYGMOGEAPH. 83 

in the case of Hughes, recorded in tracings 132 to 146, 
the extent of the disease is the measure of the patient' s 
chances of life, this feature of arterial and venous 
tension is most important. 

Accurate means of ascertaining the compressibility 
of the arteries as being so intimately associated with 
the condition of the capillaries, influenced, as we 
know these to be, by consciousness or the emotions, 
opens to physiology a field of inquiry which may 
prove of great value. 

To decide the extent to which sorrow, or love, or 
hatred, or anger, may affect the circulation and pro- 
duce disease, is assuredly important, recognizing, as 
we do, their influence in this direction ; and to ascer- 
tain by any means the influence of excitement and 
anxiety, prolonged as it is for months and years in 
this country among certain classes, is to gain an 
element of prognosis of human life. 

To sum up the value of ascertaining the compressi- 
bility of the artery, and at the same time the meaning 
of the sign itself, we have — 

1st. A means of obtaining and translating with 
approximate accuracy the record of pulsation. 

2d. We may ascertain through this the condition of 
the sympathetic and cerebro- spinal system. 

3d. We may learn the condition of the heart as to 
ability to perfectly perform its functions. 



84 THE SPHYGMOGRAPH. 

4th. We may by it learn the condition of the arte- 
ries, capillaries and veins. 

A simple experiment relative to the effect of inter- 
ference with venous circulation, and consequently 
with that of the capillaries, and in their turn the 
arteries themselves, may be worthy of record, even 
if for no other purpose than reference. 

A ligature was drawn tightly around the forearm of 
a man whose tracing was first found to be normal, and 
writings taken at intervals of one minute. 

The first of these, as may be seen (fig. 1), instantly 



/ * 

exhibited a reflected irritation, the first or shock- wave 
being prominent, although the amplitude is but slight 
and the tension 2°. 

The second shows a slight increase of this, with 
diminished amplitude and greater frequency — the 
recoil wave more pronounced. 



2 2 o 

The third shows the beginning of tension due to the 
accumulating blood. 



THE SPHYGMOGRAPH. 80 

The next gave no well-developed writing, except 
under a pressure of 5° — and in this the first and sec- 
ond events alone are visible, the recoil being slightly 
indicated but the artery failing to free itself before the 
next systole. 

k 

In the fifth, less pressure seemed to be indicated, 
probably because of the rapid accommodation afforded 
by the deep veins — other features remaining the same. 

S 

One minute later the tension was still farther reduced, 
and under a pressure of 2° the characteristic waves of 
an ordinary record begin faintly to appear. 



At this time it should be remarked, however, that 
the artery yielded tracings at 5° with readiness, but 
not differing from the one given, except in amplitude. 

This experiment, while having no particular signifi- 
cance, because involving only a partial obstruction of 
venous and capillary circulation, may yet be of interest 
as affording evidence of the rapidity of the accommo- 
dating powers of nature, and the ease with which we 
may ascertain them. 



PART II. 

CHAPTER I. 
THE PRACTICAL APPLICATION OP THE SPHYGMOGRAPH. 

The ability of any instrument to indicate a departure 
from perfect health, whether capable of also indicating 
the precise character of such departure, or not, would 
stamp it of practical value, just in proportion to its 
power to do this alone, or more certainly, or better, 
than could be done by other means. There are many 
reasons for believing that the Sphygmograph will do 
all of these ; that it will indicate a departure from 
perfect health, when not ascertainable by other means, 
is apparent in cases of degeneration of the texture of 
arteries ; and if, as suggested by modern pathology, 
"the earliest beginnings of what may be called degen- 
erative disease consist in structural alteration of the 
minutest arteries, 1 ' this fact alone would be of inestima- 
ble service. Prognosis in certain diseases, the estima- 
tion of longevity, the calculation of endurance in 
prolonged mental labor, and the danger of such labor 
where certain inheritable diseases are to be avoided, 
would find in it a valuable indicator. 

It is at once evident, that could we satisfactorily 
determine the variations compatible with health, the 



THE SPHYGMOGKAPH. 87 

Sphygmographic record of an applicant for life insur- 
ance would be the safest record lie could present as a 
test of his condition ; and this single feature could 
hardly fail to be of great pecuniary value in a country 
where the assurance of life is almost universal. Those 
who know and lament the multitude of recklessly- 
made or ignorantly or fraudulently-made certificates 
of soundness, are aware that hundreds of thousands 
of dollars are annually sacrificed that might be saved 
by some such means. 

It is believed that in the charts presented will be 
found most, perhaps all the variations due to other 
influence than disease, although still further investi- 
gation is essential to establish arbitrary rules with 
regard to them. Many observations in cases of 
known disease, or where it has been suspected, and 
impartial comparisons with a view to arrive at truth, 
will also be found in detail. 

To the professional reader, who looks over a mul- 
titude of sphymographic tracings, the first impression 
is not infrequently one of disappointment. There is 
a sameness at first apparent, which would tend to 
suggest the inefficiency of the instrument as a means 
of diagnosis, or even of ordinary usefulness ; but 
such is also the case with the hieroglyphs of Egypt, 
the characters of the Chinese and Japanese language, 
or even with the facial features of a barbarous 



08 THE SPHYGMOGRAPH. 

nation ; yet in one case as in the other, upon every 
minute angle or curve, there is a significance, and 
careful scrutiny or maturer knowledge will reveal it. 

That there is a peculiarity in each tracing is best 
seen by taking one of any kind, except the smooth 
uninterrupted wave of exceptional health, and com- 
.paring it in succession with others arranged upon a 
chart. Frequently fifty, sixty, or more, will be passed 
over, and no satisfactory similarity appear. This, 
however, it should be remarked, is not the case, if, 
confining ourselves to what we have hitherto discussed, 
we compare particular points in tracings, for example : 
similarities in venous or arterial pressure, in ampli- 
tude of systolic wave, or suddenness of diastolic col- 
lapse, etc. 

Although the tracings originally presented with 
this essay have been reduced in number, from 1,000 
to 275, yet even so large a number as the latter will 
perhaps seem superfluous, if judged from the stand- 
point of our present limited knowledge, and looking 
only for the features enumerated ; but as in the de- 
tails of interesting cases the most useful facts are 
often elicited, so with cases whose clinical signifi- 
cance is recorded by the impartial pen of the Sphyg- 
mograph, only in details can be furnished the infor- 
mation we seek, and of these the student can for 
himself judge the practical value. 



THE SPHYGM0GRAPH. 89 

These tracings are designedly arranged in a some- 
what promiscuous manner ; they are selected from 
among several thousands, and though incomplete and 
unsatisfactory in many instances, the enormous ex- 
tent of the field of inquiry to be thus explored, the 
maze of uncertainty and doubt that has surrounded 
the efforts of workers hitherto, and the fact that 
each disease should require weeks and months of 
patient investigation, must be the apology for such 
incompleteness ; it is a necessity growing out of the 
magnitude of the work. 

The whole practical value of the Sphygmograph 
can, in fact, only be ascertained by the completion 
of a dictionary, to which each individual tracing can 
be referred for interpretation, and towards this object 
these tracings are a contribution. 

Another reason for presenting, in such profusion, 
tracings not at first strikingly dissimilar, is that to 
the reader or student may be furnished the amplest 
means for study of their value. 

Careful scrutiny and comparison are invited, since 
the more minutely they have been studied by myself, 
the more firmly has the conviction grown that our 
present attempts at translation are defective, and that 
there yet may be found new keys that will unlock 
features of new interest. The difficulty of finding a 
tracing to perfectly correspond with one we may wish 



90 THE SPHYGMOGRAPH. 

to translate has already been referred to, but is made 
remarkable by the fact that the tracings of any one 
individual always indicate a singular resemblance, 
however great the interval of time, provided, of 
course, that no new or greatly exaggerated disease 
shall have intervened. This resemblance is sugges- 
tive of the features of the man himself, changed by 
the form of the beard, the advance of years, or the 
defacement of illness or trouble, it is yet the face of 
the same man and rarely loses its peculiar charac- 
teristics. 

To make the study of these and similar records 
of value, certain rules should be observed, e. g. 
tracings taken at different pressures ought not to be 
compared. (This was done on the charts originally 
presented, but solely for illustration.) Single trac- 
ings should not be compared, but the several trac- 
ings of each sitting should be combined. 

It should not be forgotten, that as tracings at dif- 
ferent pressures cannot be all characteristic of the 
condition at the time, where several are found differ- 
ing materially, only that should be considered signifi- 
cant which brings out the most fully the different 
elements of the pulse wave. 



Note. — All the tracings herein given are from the radial arteries, not copies 
ir fac-similes, hut the tracings themselves as they fell from the instrument. 



CHAPTER II. 
DESCRIPTIVE NOTES IN CONNECTION WITH TRACINGS. 

As already stated, one of the first steps in the 
application of the Sphygmograph to physiological or 
pathological study, is to ascertain the variations com- 
patible with health. To do this, numerous examples 
have been selected, in which a rigid examination by 
the ordinary appliances of modern science failed to 
detect organic disease, and observations of these are 
given as made under different circumstances. 

The first two tracings (Nos. 1 and 2) are those of a 
physician of middle age, in robust health. 

The even wave, at a normal pressure, is a satis- 
factory index of the condition of the heart and general 
circulation. At a greater pressure, after exertion and 
excitement, there was a prominence developed in the 
wave of recoil. At a still greater degree of pressure, 
and after loss of rest and fatigue, there appears a sus- 
picion of disease. (No. 2.) 

Reflecting, however, upon the influence of nervous 
prostration in producing capillary contraction, and 
slight increase of arterial tension, and that the round- 
ness of the systolic wave when resulting from disease, 
generally accompanies a much higher degree of arte- 



92 THE SPHYGMOGEAPH. 

rial tension, the tracing may be considered not incon- 
sistent with health. 

A comparison may be made with other tracings, 
e. g. No.. 180, of a man who exhibited certificates to 
the effect that he was suffering from immense aneurism 
of the abdominal aorta, and is interesting as corrobo- 
rative testimony that the man was an impostor ; 
certainly his tracing was indicative of no serious 
departure from health, and careful examination failed 
to detect the disease. (See Aneurism.) 

Tracings Nos. 3 and 4 are the record of a young man 
addicted to the excessive use of tobacco. The per- 
verted nervous element in the wave of primary shock, 
and of recoil, are the only features of interest. 

The same exhibition from a different, yet analogous 
cause, is seen in the writings of Asthma. (See 
Asthma.) 

Tracings 5, 6 and 7 are from a gentleman mentally 
overtaxed, but in whom no organic disease could be 
found. 

The next tracings aie illustrative of the influence of 
various minor disturbing causes. The first (No. 8) 
appears to show the smooth wave of health at a press- 
ure of 0°. The exertion of running up stairs quickly 
made a variation in arterial tension of 2|°. The smok- 
ing of a strong cigar also varies the tension to a slight 
extent (No. 10). Smoking to faintness at once reduces 



THE SPHYGMOGRAPH. 93 

this to 0°, and modifies the tracing to an extent, show- 
ing impairment of the heart' s propnlsive power (No. 11). 

A full meal does not appear to influence the tension 
of the artery, nor, indeed, to modify the record of 
health first given, except as to frequency. The same, 
witli wine, however, changes it as to frequency, ampli- 
tude, rhythm, and tension (No. 12). Under a less 
pressure there appeared a slowness of collapse of the 
artery, but no other change. 

After exciting news a change occurs, almost like 
that due to faintness, and probably explainable in the 
same way, although the pressure differs (No. 13). 
Anger, however, an emotion similar to that of surprise 
and excitement implied in the former example, while 
not modifying the tension of the artery, exhibits the 
increase of excitement in the heart itself without the 
discharge of any increased volume of blood from its 
aortic orifice ; an event, however, which would prob- 
ably result at a later period, if the emotion were pro- 
longed (No. 14). The last two examples, taken during 
a condition of fatigue, will probably need no addi- 
tional comment (Nos. 15 and 16). 

The following cases, also of apparent health, show 
the effects of obtaining a correct estimate of pressure 
employed in the observation, and the possible signifi- 
cance of a former disease. Please observe, these are 
cases of apparent health only. 



94 THE SPHYGMOGRAPH. 

Tracing No. 17. A suspicion of cardiac complica- 
tion, growing out of rheumatism, is indicated in the 
tracings of this case, as brought out by the increase 
of pressure upon the instrument up to 2°. The pa- 
tient, a male, age 30, had frequently suffered from 
cough and suggestive evidences of tendency to pul- 
monary disorder ; yet, although delicate, he could not 
be said to be actually ill. 

Tracings 18 and 19 exhibit nervous elements, due to 
widely different causes, and, in 19, actual valvular 
disease has been since detected. 

Tracing No. 20. This tracing is the record of a man 
in apparently robust health, yet occasionally subject 
to pain over or in the apex of the heart. No lesions 
could be detected by examination. At the age of 25 
he had raised blood on several occasions, but, neither 
at the time nor subsequently, was there any cough. 

A man of nervous energy and business talent, he 
has attained prominence and wealth by his own exer- 
tions. 

Tracing No. 21. This is the record of a lady, age 
50, subject to attacks of suffering from a chronic ova- 
ritis, but whose lungs were found to exhibit evidences 
of former and somewhat serious disease. 

Tracing No. 22. This case is one of considerable 
interest, since, although to all appearances in vigorous 
health, any confinement at in-door work invariably 



THE SPHYGMOGRAPH. 95 

produces debility and cough. A man of about 42, of 
sanguino-bilious temperament, accustomed to travel 
and to out of door pursuits ; lie maintains a condition 
of apparent health, the only exception to which, is a 
trivial indigestion and follicular pharyngitis. Fifteen 
years ago he suffered from hemoptysis, the origin of 
which is faintly suggested by impaired vesicular mur- 
mur at the apex of the left lung, with scarcely appre- 
ciable dullness on percussion. 

Tracing No. 23. Miss G., age 18, of ruddy com- 
plexion, of petite form, vigorous and well. No or- 
ganic disease could be detected, and the occurrence of 
palpitation and simple functional disorders alone ex- 
isted, probably due to inordinate dancing. 

Tracing No. 24. Mr. J. E,., age 30, phlegmatic 
temperament, addicted to abuse of tobacco, and sub- 
ject to slight cardiac disturbance. 

Tracing No. 25. Mr. M., age 32, sanguino-nervous 
temperament, robust and vigorous, but suffering occa- 
sional cardiac disturbance from abuse of tobacco. 
The condition of nervous hyperesthesia and its in- 
fluence in producing tension, shock wave, and wave of 
recoil, are plainly indicated in the writing. This case 
may be compared with one of suffocative bronchitis, 
being singularly like and yet unlike (No. 26). It is 
not improbable that the condition of the pulmonary 
circulation, arising from the suffocative bronchitis un- 



96 THE SPHYGMOGEAPH. 

der wMcli the patient labored, may be the cause of the 
prominent recoil wave, and indicative of obstruction 
sufficient to react on the right ventricle, and so through 
the left upon the systemic circulation. 

Tracing No. 27, is that of a gentlemen, Mr. H., age 
23, pale, nervous and debilitated, and exhibiting the 
marks of other excesses than tobacco, to which, how- 
ever, may be attributed the principal amount of nerv- 
ous depression. The marked difference exhibited 
by the tracings of such a person, whose arterial ten- 
sion was not abnormal, and the preceding, is of 
interest. 

The indication is simply that of reaction after pro- 
longed nervous excitement. 

Tracing No. 28, Mrs. V., age 34, married, and to all 
appearance and examination sound, with the excep- 
tion of anteflexio uteri and globus hystericus. The 
comparison of this with cases of disease, can only be 
reconciled by the fact of difference of pressure. 

A singular resemblance of the record to one com- 
mon in obstructive valvular disease, but which it is 
unnecessary to give in this connection, shows several 
facts already alluded to in the preceding pages. 
First, that obstruction at or near the heart will pro- 
duce a prolonged and flattened systolic wave, as 
marked as may be produced by obstruction more re- 
mote ; and second, that the wave of recoil, when co- 



THE SPHYGMOGBAPH. 97 

existent with such a systolic wave, means, except when 
the tension is great, organic disease. 

Were this exception not true, the records of Nos. 
25 and 26 would seem to mean organic and not 
functional change. 

Tracing No. 29, Miss P. W., age 26, suffering from 
debility, ascribed by herself and friends to simple 
nervous derangement, came under observation for a 
supposed cancer of the uterus, having seven months 
previous, undergone the torture of removal of a be- 
nign growth from the right breast by caustics at the 
hands of a charlatan. This growth, there is abundant 
testimony to pro^e, was of long standing, painless, 
not growing and not cancerous. No uterine disease 
whatever was found, nor indeed, any other organic 
trouble ; the chief and only symptom of note was a 
pulsation of the abdominal aorta when the patient 
was lying on her back, sufficient to be perceived 
across the bed chamber and to lift the bed clothing. 

The tracing is of the right radial. The abdominal 
aorta and other radial gave a similar record, varying 
only in amplitude. 

The feature of interest in this case relates to diag- 
nosis. From the tracings obtained, the opinion was 
given to the relatives that no organic disease existed, 
but that the pulsation was due to deranged nervous 
action, probably of the tri-splanchnic system, and that 



»0 THE SPHYGMOGEAPH. 

the disorder would disappear under a simple course 
of tonic treatment. 

Subsequently this opinion was verified by the recov- 
ery of the patient. The case of cardiac disease in the 
patient with phlebectasis laryngea, (already alluded 
to in connection with description of the 4th event, 
see No. 64,) while similar, yet differs in essential 
points, and illustrates by its recoil and primary shock 
wave, occurring with flattened systolic distension and 
low compressibility, the existence of organic disease. 
In the former case the backward inclination of the 
primary ascent would indicate a singular predomi- 
nance of some nervous element. 

Tracings 30 and 31. These were both apparently 
healthy men of 30 and 33 years of age, respec- 
tively, who had lost each the left arm some years 
before. Taken as extremes of difference in cases of 
men free, to all ordinary modes of detection, from 
organic disease, they show that in both there was 
departure from perfect health. In the first, more care- 
ful examination revealed a peculiar murmur with the 
cardiac systole, loudest over the innominate artery. 
The young man was found also to be suffering from 
malaise due to overwork. 

The murmur has since become almost inaudible, 
but the tracings remain the same. How far the loss 
of arm may be the cause of the record it is impossible 



THE SPHYGMOGKAPH. 99 

to say. The other case, in which the arm had been 
amputated, exhibits the oscillatory motion of the blood 
in a normal tracing, dne to the simplest of the canses 
assigned for this phenomenon, (see p. 72) viz : dis- 
torted inhibitory function ; and in this case arose from 
an excessive nervous vitality and impatience to be 
away. The patient was a mail carrier, leading, of 
course, an out-of-door life. 

Tracings 32, 33 and 34. These are designed to illus- 
trate the variations due apparently to debility. The 
pressure, it will be seen, is slight. While many other 
changes in tracings are undoubtedly the results of 
debility, these have been selected as more frequently 
occurring than others. Household cares, prolonged 
anxiety, the bearing of children, etc., seemed to have 
been the cause of the impairment of health. 

Tracings 35 and 36. These tracings, from an 
hysterical female, exhibiting a high degree of arterial 
tension, were unaccompanied by any evidence of dis- 
ease, whatever ; the person being a young lady, age 
18, vigorous and sound so far as a most rigid exami- 
nation could show her to be so. The high tension was 
ascribed to functional disturbance, although the lady's 
father and other relatives have suffered from cardiac 
disease. 

Tracing 37. This is from a lady subject to hys- 
teria, but, unlike the preceding, not otherwise sound ; 



100 THE SPHYGMOGKAPH. 

a prolonged leucorrhcea and displacement of uterus 
having induced a condition of impaired health. She 
was married and the mother of several children. The 
tracing is, however, submitted as that simply of hys- 
teria. 

Tracing 38. This exhibits the injury to the ner- 
vous system that may arise from excessive use of 
tobacco ; the person being a thin, delicate male, aged 
33. 






CHAPTEE III. 
CASES CHIEFLY OF CAKDIAC DISEASE. 

Tracing ISTo. 39. Mr. C, age 24, has suffered from 
much cardiac disturbance, faintness, palpitation, and, 
at times, slight irritative cough. The low tension, the 
nervous element, and dicrotism are chiefly marked, 
and were connected with capillary relaxation, due to 
dissipation. An existing increase in cardiac impulse 
does not appear in the tracing, probably because not 
transmitted as far as the radial artery. The patient 
has since recovered. 

Tracing No. 40. A man, age 68, with all the ex- 
ternal and familiar evidences of advanced cardiac 
disease, and with the double beat of the heart faintly 
perceptible in the peripheral arteries. The irregular 
form of the tracing is a point of interest, not hitherto 
dwelt upon in this essay. 

Prof. Sanderson, in his work on the Sphygmograph, 
p. 35, describes the peculiarity for the first time, and 
ascribes it to the mechanical effect of inspiration dur- 
ing a mitral disease, accompanied by regurgitation. 
Such it probably is in this case, the short and ineffec- 
tual beats occurring during inspiration, the others 



102 THE SPHYGMOGEAPH. 

during the respiratory pause. He speaks also of a 
similar pulse due to certain dyscrasise, but, as I have 
thus far failed to observe it, time need not here be 
taken to dwell upon his brief remarks concerning it, 
particularly, as the dyscrasise referred to are not speci- 
fied, nor tracings given. He, however, ascribes the 
failure of the heart, as evidenced in the short beats 
here given, to the non -closure of the mitral valves at 
the time of inspiration, and their partial or perfect 
closure when the relaxation of the pulmonary capil- 
laries, during the respiratory pause, allows the auricles 
to free themselves sufficiently from their state of dis- 
tension to permit the valves to fall together. Another 
and most interesting case of this disease is given in 
connection with tracings 74, 75 and 76. 

It should be remarked that these changes in ampli- 
tude of the waves occur when the regurgitation and 
other disease are such that the valves are not perma- 
nently kept open. In the latter cases, the valves 
failing to close even during the respiratory pause, the 
efforts of the heart are all short and ineffectual. The 
effects of stenosis of the mitral valves, or such obstruc- 
tion as to interfere with a perfect and rapid filling of 
the ventricles from them, would, of course, present 
different tracings, examples of which will be hereafter 
given. 

Tracings Nos. 41, 42, 43 and 44. These are from a 



THE SPHYGMOGEAPH. 103 

case of threatened apoplexy, in a man with pre-exist- 
ing baso-systolic murmur, showing influence of treat- 
ment and relief of vertigo. Mr. O., age 52, of florid 
complexion, short neck but not particularly apoplectic 
in appearance, formerly a butcher, for two years book- 
keeper, and for many years robust and well. Having 
been, for a year, subject to slight attacks of dizziness, 
he came under observation when these had become 
alarming, and so severe as to seriously interfere with 
business. Twelve years prior to this he had suffered 
from subacute attacks of rheumatism, but never sup- 
posed the heart implicated in any way. 

The subjective condition was as follows : Vertigo 
upon slight exertion, no numbness or tingling or 
especial headache, no impairment of sensation or 
motion. Recovery in two months from date of the 
first tracing given. Treatment: cardiac and arterial 
depressants and rest. The baso-systolic murmur was 
slight, and the patient is yet unaware of its existence. 
The difference between the tracings, under similar 
pressure, is probably due to easily aroused nervous 
apprehension. Tracing No. 44 exhibits the result of 
treatment. 

Tracing No. 45. This was a case of vertigo and 
threatened apoplexy without heart disease, the impair- 
ment being functional. The patient was a young girl, 
age 17, assistant to a dentist, who exhibited similar 



104 THE SPHYGMOGRAPH. 

symptoms to the preceding, but to a worse degree. 
Treatment the same, and recovery speedy. 

Tracings No. 46, 47, 48 and 49. The record of this 
case is given somewhat in detail, because of the easily 
ascertained associate symptoms, and a personal knowl- 
edge of the patient many years. It is that of a man 
66 years of age, having the appearance of vigorous 
health, indeed, confined to the house but once for a 
few days for fifteen years ; hardy, muscular, and en- 
during, with the appearance of a person many years 
younger. The tracings were taken at varying inter- 
vals, during the past two years. Formerly, and 
within three or four years, murmurs, both with first 
and second sound of the heart, were audible ; and the 
exaggerated impulse, increase of area of dullness, 
changed position of apex, etc., indicated hypertrophy 
accompanied by disease of aortic and intra-cardiac 
valves. As this enlargement has advanced, the mur- 
murs have diminished in intensity, the impulse has 
grown less, and the frequency, formerly singularly 
reduced, (to 42 beats per minute), has increased, so 
that, at times, it will be found 60 or even 70 beats per 
minute. 

The change that has occurred may be, in some 
measure, discovered in the comparison between the 
tracings. 

Those taken at 2° show what variations may occur 



THE SPHYGMOGEAPH. 105 

in the same individual during the progress of organic 
disease. 

It should be stated that, whereas, formerly (tracings 
not given) a pressure of 5° was necessary to obtain an 
ample tracing, the gradually impaired expulsive power 
of the heart has made such pressure, only on one 
occasion, allowable. within the past two years. The 
artery no longer has the firm, cordy feeling then 
exhibited, although the patient is remarkably free 
from external evidences of degeneration, such as no- 
ticeable arcus senilis, etc. 

One other feature of interest appears, viz : the sug- 
gestive resemblance, in one or more of the tracings, to 
the records of aortic regurgitation. In one instance 
only is it likely that this phenomenon occurred, and 
as it has never been repeated in the case, we may 
suppose that the obstructive disease of the valves, 
which undoubtedly exists to a slight degree, may have 
permitted a temporary regurgitation. 

Improbable as this statement may be considered, 
the record is impartial, and the sudden collapse of the 
artery, from some cause, is indisputable. It is hardly, 
I think, to be confounded with oscillation. 

The last three writings, taken at the same date, 
showed the importance of not accepting a single tra- 
cing, at a low pressure, as the true record of a patient ; 
one of these, however, only is given. 



106 THE SPHYGMOGRAPH. 

Tracings Nos. 50, 51, 52, 53, 54 and 55. This case is 
one of pericarditis with effusion, and is of peculiar 
interest. It may be briefly stated, as follows : 

Mr. , age 25, of average height and weight, and 

dark complexion, had been annoyed for a considerable 
period by a cough, to him significant and alarming, 
because of a supposed family predisposition to affec- 
tions of the lungs. After resorting to cod liver oil 
and expectorants, et id omne genus, he came under 
observation, somewhat weakened, and suffering from 
occasional slight fever. No disease of the lungs or 
heart could be discovered, and a chronic pharyngitis, 
with partial involvement of the larynx down to the 
ventricular bands, seemed to be the sole source of 
trouble. The disease of the pharynx was of the fol- 
licular variety ; that of the larynx, as would be natur- 
ally expected, glandular. No pyriform enlargement 
of the ary-epiglottic folds, nor other suggestion of 
incipient phthisis. For a real or fancied pain in the 
chest he smeared the whole of the front of it with 
croton oil. In twenty-four hours he was found with a 
severe urticaria, involving the whole body, and twelve 
hours later, with effusion into all the serous cavities of 
the body ; that of the joints considerable ; of the heart 
the least. Weakened by this disease or affection, 
and while the condition of the heart was far from 
satisfactory, he went into the country for his health, 






THE SPHYGMOOKAPH. 107 

and resorted to prolonged and violent exercise in 
rowing, etc., with the effect of bringing him speedily 
to bed, with a thoracic pain and increased pericardial 
effusion. During the labored action of the heart, a 
stasis was discovered in the apex of one lung, and a 
circumscribed pleurisy followed. Most rigid examin- 
ations, frequently repeated, warranted the belief that 
this was a result of the heart's condition, and the 
opinion has since been verified by the perfect recovery 
of the patient. Before the effusion into the pericar- 
dium had been absorbed, an endo-cardial inflammation 
occurred, and, as convalescence began and continued, 
it was evident that hypertrophy would result to a 
greater or less degree. 

The cough, which had thus far been annoying rather 
than painful or distressing, continued, and when final- 
ly the treatment of the intra-thoracic disorder could 
be abandoned, local treatment under the laryngoscope 
completely removed it. After so great a lapse of time, 
however, (June to September,) the upper part of the 
trachea had become involved and required especial 
attention. 

Dec. 1st, 1872. The lungs were found free ; pulse 
under the finger normal, but with the Sphygmograph 
indicative of weakness of the heart's action. The 
same tracing resulted "from observations at any press- 
ure from 0° to 5°. The last tracing, unusual and 



108 THE SPHYGMOGEAPH. 

peculiar, lias been quoted on chart opposite page 45. 
The whole case is worthy of study, and from a sphygmo- 
graphic point of view might occupy a complete essay. 

Tracing No. 56. This is the record of a man, age 
50, in the dropsical stage of cardiac hypertrophy with 
regurgitation. This tracing resembles strongly that 
usually given by the carotid, (see p. 75). 

Tracings Nos. 57, 58, 59 and 60. This case is that 
of a fireman, with slight hypertrophy and baso-sys- 
tolic bruit, and exhibits the effect of treatment. The 
patient seems since to have recovered. Aside from the 
cardiac murmur with occasional palpitation and dysp- 
noea, the party suffered from sleeplessness, for which 
trouble he came under treatment. The relief of this 
by remedies permitted the development of a tracing 
quite different from any in the first series, but giving 
no indication of the cause of a systolic bruit at the 
base of the heart. The suggestion would rather be 
that of some mitral trouble, if valvular at all. The 
facts only are stated, and the diagnosis of slight 
hypertrophy with dilatation was made with no refer- 
ence to the tracings. I have no doubt, that with 
greater experience and care, more satisfactory tracings 
could have been obtained. The greater frequency of 
the pulse after treatment is remarkable, in connection 
with the fact of complete relief from all unpleasant 
symptoms. 



THE SPHYOM0GRAPH. 109 

Tracing No. 61. A case of Hypertrophy (concen- 
tric), with exaggerated impulse sufficient to give thrill 
to the hand over the whole chest, a systolic murmur 
at the base of the heart, and occasional hsemoptyses 
without tubercle. After what has been said concern- 
ing similar cases, this one need not be dwelt upon, 
save to call attention to the slight pressure permitted 
by the artery. 

Tracings No. 62 and 63. This case, that of a young 
lady, age 23, is interesting and worthy of a brief no- 
tice, because exhibiting the flattened wave partly due 
to the conjunction of the first and second events ; but 
chiefly to the prolonged effort of the heart to force its 
contents into the aorta against some obstruction at the 
orifice of exit. 

This wave aptly illustrates the description of the 
condition given by Blakeston (Observations on Dis. of 
Chest. Amer. Ed. p. 225), in which the blood is said 
to be gradually squeezed through the contracted 
orifice. A case of aortic valvular obstruction. 

Tracings Nos. 64, 65 and 66. In this the same con- 
dition as the preceeding, is shown with an accompany- 
ing regurgitation. This case possessed many features 
of interest which cannot be given in detail. The prin- 
cipal source of trouble, for which alone relief was 
sought was a sense of fullness in the larynx, which 
was always relieved by a local application. The dis- 



110 THE SPHYGMOGEAPH. 

ease of this structure was probably due to the cardiac 
trouble, and, in fact, led to an examination of the 
heart, of the condition of which the patient was 
aware. 

Tracings No. 67 and 68 continue the case, the pro- 
gress of which was watched with considerable interest, 
the heart having grown steadily more troublesome. 
At the present time, however, after a prolonged rest, 
all very unpleasant symptoms, with exception of oc- 
casional slight faintness upon exertion and nervous 
chills, have disappeared. The results obtained by 
varying pressure are worthy of note. 

Tracing No. 69, of a man supposed sound, but 
subject to occasional vertigo, (age 56,) may be com- 
pared with advantage. 

Tracings Nos. 70, 71, 72 and 73, may be briefly des- 
cribed as those of a young man (age 30), with disease 
of mitral and aortic valves, and hypertrophy (concen- 
tric). The confusion of sounds in the chest is in- 
describable ; and although the party has the ruddy 
appearance of health, these sounds, like the rushing 
and tumbling of many waters, can be heard when the 
observer is sitting close beside him. A regurgitant 
mitral murmur can alone be separated distinctly from 
the confused mixture of noises. The patient had been, 
prior to 20 years of age, a sufferer from frequent 
attacks of inflammatory rheumatism. The most inter- 



THE SPHYGMOGRAPH. Ill 

esting subjective feature in his clinical history is his 
liability to attacks of extreme dyspnoea immediately 
after any exposure to draughts of cool air, or the wet- 
ting of the feet, etc. 

Tracings Nos. 74, 75 and 76 are of a young lady, age 
18, in whom, for eleven years, some heart disease has 
been known to exist. Of fair complexion and rosy 
cheeks, she presented to the eye no evidence of disease, 
yet, by auscultation and percussion, it was a matter 
of no difficulty to locate the seat of a serious organic 
change in the left side of the heart. 

The tracing is a good example of that form of dis- 
ease already discussed on p. 101, see tracing No. 40, 
and differs from the case there cited, but little, in 
extent of organic change. In neither, as will be 
observed, is there as yet any failure to fill the arteries, 
and while a pressure of 5° is necessary to bring out 
in perfection the peculiarities of the writing in the 
latter, (a low or normal pressure hardly suggesting 
the existence of the regurgitation that is so evident in 
the other records), yet, in the case above referred to, 
on p. 101, a pressure of 0° only could be tolerated, 
and the accompanying symptoms indicated a more 
advanced stage of the disease. Had the amount of 
regurgitation been more excessive in one than the 
other, we should probably have had all the waves 
exhibiting evidences of inefficiency in the tracing, 



112 THE SPHYGMOGRAPH. 

instead of every second and third. It is not unlikely 
that nervous or tendinous tremor is the source of the 
apparent oscillation in the second record of the series, 
since it is so nearly obliterated from the one that 
follows, under an equal pressure, and as we know the 
influence of nervous excitement upon a person suffer- 
ing from this disease, we may correctly attribute the 
increased tension, also to it. Singularly contrasted as 
the successive waves are, the pulse to the touch but 
faintly suggested irregularity. 

Tracing No. 77, exhibits a suggestive abnormality to 
which, however, the most careful physical examina- 
tion gave no corroborative testimony. The patient, a 
young lady, age 26, of superior intelligence, believed 
herself to have inherited some affection of the heart 
from her father, her pulse having for several years 
been above 95. No increased area of dullness and no 
murmur existed, nor was the rhythm, impulse or pitch 
of the valve sounds at all modified. The similarity of 
the record, however, to that of No. 72, is interesting, 
in view of the family tendency to cardiac disease, and 
the patient's habitually rapid pulse. It may be re- 
marked that she was and has been for years in other- 
wise robust health.* 



* Since this record was made the patient has suffered from attacks of alarming 
syncope. 



CHAPTER IV. 
AFFECTIONS OF THE NERVOUS SYSTEM. 

Tracings Nos. 78, 79 and 80. This case was that of 
a large, well developed, vigorous man, taken during 
convalescence from mania-a-potn, or rather after the 
most violent symptoms were brought under control by 
treatment. These tracings are types of those obtained 
under similar circumstances, but differ materially from 
those given in Reynold's System of Medicine, by 
Prof. F. E. Anstie. What may be the cause of this 
discrepancy I am unable to say ; but as my object 
now is simply to give the reader the results of per- 
sonal observation, any attempt to reconcile them would 
be out of place. It will be observed that the amount 
of pressure in this case does not vary perceptibly the 
amplitude of the tracing. 

A Sphygmographic observation taken later, gave 
only a low, wavy tracing, showing extreme nervous 
debility. 

Tracing No. 81, is that of a man of 56, supposed 
well, but in whom the second sound of the heart has 
a peculiar intensity. He is subject to vertigo, and 
undoubtedly is, to some extent, unsound. 



114 THE SPHYGMOGEAPH. 

Tracings Nos. 82, 83 and 84, are examples of simi- 
lar troubles ; and being in no wise peculiar, time need 
not be occupied by further comment, save that the 
latter being the record of a hard drinker, quite recent- 
ly a sufferer from sun-stroke, exemplifies the remark 
on page 73, that oscillation may be due to either 
" severe cerebro-spinal disturbance" or "blood poi- 
soning," both of which existed in this case. 



. CHAPTER V. 

CASES OF ASTHMA, AND VAKIETIES OF SAME. 

Tracings Nos. 85, 86, 87 and 88, are from a patient, a 
male, age 33, laboring under an asthma, complicated 
with bronchitis — a true suffocative bronchitis. The 
first two exhibit the combined respiratory act. The 
period of observation lasted from August 20th, the 
date of commencing treatment, to Sept. 16th, at which 
time all asthmatic symptoms had been relieved, and 
the subacute bronchial inflammation was progressing 
rapidly toward recovery. A state of excitement of 
the nervous system is evident during the activity of 
the disease, and one of cardiac asthenia during con- 
valescence. 

Tracing No. 89, is that of a young girl, age 9, who 
for six years has suffered occasional attacks of asth- 
ma. She shows, under physical examination, evi- 
dences of slight dilatation of the right ventricle, and 
has the asthmatic shrunken chest. She has suffered 
from frequent palpitation of the heart and insomnia. 

Tracings Nos. 90 and 91, are the record of a life- 
long sufferer, age 56, who has since died. At the time 
of examination, being very weak, he was found to 



116 THE SPHYGMOGKAPH. 

have excessive dilatation of the heart, and donble em- 
physema. A distressing dyspepsia added its tortures 
to, his disease. The attacks of asthma had* been 
nightly for thirty years, with very rare exceptions. 

Tracing No. 92 is a case of Autumnal Astlima, 
accompanied usually by bronchitis in a severe form, 
but this year with but slight implication of the 
bronchi. A male, age 40, a brewer. A curious fact 
in this case is worthy of record. Each year, after 
recovery, he has for several years voided urinary 
calculi (mulberry variety) in considerable numbers, 
although no symptoms have ever pointed to the kid- 
neys as a source of trouble at other times, and never 
during the paroxysms. The record was made during 
the day, the attacks being usually at midnight or 
shortly after. 

A high degree of pressure was necessary to produce 
an ample and satisfactory tracing. 

Tracings Nos. 93 and 94 represent the record of a 
robust man, age 32, for five years a sufferer from 
true uncomplicated astlima ; attacks diurnal, sudden, 
protracted and severe. 

In this, as in all cases where not otherwise ex- 
plicitly stated, the tracings given were taken before 
the use of remedies, and during the day. 

Tracing No. 95 is from a lady, age 32, suffering from 
cardiac dyspnea, supposed to he asthmatic. 



THE SPHYGMOGEAPH. 117 

The heart is hypertrophied, the apex beat being- 
above the fourth rib, and displaced 2|- inches to the 
right ; systolic sound double, and diastolic very sharp 
at the base and also at .the apex of the left lung. 
(The urine in this case was found on several occasions 
highly albuminous.) 

Tracings JSTos. 96 and 97 are from a robust man, age 
42, with ordinary autumnal asthma, beginning, as is 
usual in such cases, in August of each year ; no 
marked complications. 

Tracing No. 98 was similar to the preceding as 
regards the age of party and character of the disease, 
but differed in being not autumnal. The patient, a 
sea captain, has been long subject to slight bronchitis, 
with asthmatic difficulty of breathing, whenever re- 
maining a few nights on shore. He was found to have 
consolidation, without softening or outward symptom, 
at the apex of the left lung. 

Tracings ISTos. 99 to 111 inclusive, are examples of 
supposed progresso-loco-moto ataxia. In all of them 
there seemed but little doubt as to correctness of diag- 
nosis, and in the first two (99, 100, 101, 102, 103, 
104, 105 and 106,) no corroborative symptom was 
wanting. In the others the impaired co-ordinating 
power, the severe neuralgic pains, the duration of the 
affection, the occasional ptosis and the limitation of 
the distinctive phenomena to the lower extremities, 



118 THE SPHYGMOGRAPH. 

were present, and the absence of any symptoms point- 
ing to other cerebral or spinal disease, seemed to war- 
rant the diagnosis given, although the yonth of one of 
the parties was somewhat against the correctness of 
the opinion. 

(Case 99 to 101 inclusive.) Mrs. B., wife of Judge 
B., aged about 50, ill five years ; duration of marked 
inco-ordination of motion one and one-half years. 

(Case 102 to 106 inclusive.) Mr. G. , age 52, duration 
of illness, six years. The first two tracings were taken 
October, 1872, the next a month later and the last two 
a month later still. In November the record states 
that " Strabismus and persistent ptosis" existed. 

(Case 107 to 109 inclusive). Miss J., aet 18, ill four 
years ; unable to walk three years past. 

(Case 110 and 111.) Mr. E., age 26, ill three years. 

All the cases are yet living, that of (case 102 to 106) 
alone showing the approach of the end ; and in each 
without exception, (although the fact has no bearing 
upon our present subject,) it may be interesting to 
note that amelioration and relief has followed the use 
of large doses of ergot and phosphoric acid. From a 
Sphygmographic view, several points of interest may 
be noted. First — In two of the cases, it was almost 
impossible to obtain similar writings from the right 
and left radial s. 

Second — In the two cases most advanced, a degener- 



THE SPHYGMOGEAPH. 119 

ation of the arterial tissues, or at least the impairment 
of their elasticity, is indicated. 

Third — The record of the young lady, age 18, (107, 
108, 109) exhibits the least aberration from a healthy 
standard, and a favorable prognosis based upon it 
alone, although made after long treatment, under 
other physicians, and much discouragement, has been 
verified in the rapid improvement of the patient. The 
similarity of the tracings to those taken from my own 
arteries, while under the influence of certain nervous 
sedatives, is well marked. 

Fourth— Tlie record of Mr. E., age 26, (110 and 111) 
while failing to justify a favorable prognosis, because 
of the evident impairment of the impletive power of 
the heart and the inference of severe cerebro-spinal 
disorder, drawn from the oscillation of the writings, is 
yet instructive. Under the treatment already indi- 
cated, combined, however, with remedies required for 
a distressing insomnia, the patient has so far recovered 
as to be free from the boring and neuralgic pains, is 
able to walk about with no great difficulty, to sleep 
and eat with the appearance of returning health. 

It is by no means designed to intimate that these 
cases are destined to ultimate recovery; but only to 
emphasize the fact that the organic and structural 
change appeared in them less advanced than in the 
others. The languor of the systolic action of the 



120 THE SPHYGMOGRAPH. 

heart, as evidenced by the slope of the primary ascent 
of the tracing ; the irregularities of rhythm ; the vari- 
ations in frequency and pressure ; the tendency to 
an oscillation in no measure due to tendinous or 
muscular tremor (because none existed), may all be 
set down as marks of a serious organic derangement 
of some kind. 






CHAPTER VI. 
SINGULAR CASES. 

Tracings Nos. 112 and 113. The tracings of this 
patient are not easily explained. A saloon keeper, 
age 35, and for years never ill. He was taken with 
chills, accompanied by alarming symptoms indicative 
of congestion of thoracic organs. The tracings were 
taken during the intermission. The paroxysms seemed 
without reasonable room for doubt, those of quotidian 
ague, running somewhat rapidly into a remittent 
fever. This became again intermittent under treat- 
ment, and recovery followed within three weeks. 

The resemblance borne by the tracings of this case 
to many heretofore tabulated is somewhat remarkable ; 
and as the changes in the records since recovery still 
show some abnormality, it is not unlikely that the 
heart at least has sustained severe damage. To all 
appearance, however, recovery has been complete. 

As this has been the only case of the kind, of which 
I have obtained records, it is unfortunate that no 
proper comparisons can be made. The whole number 
of tracings made in this case, however, was perhaps 
forty. 



122 THE SPHYGMOGEAPH. 

Tracings No. 114, 115 and 116. This is the record of 
a case of schirrhus of the breast, which caused death by 
exhaustion, three years after its discovery, and with- 
out operation (if we except an attempt to cure by 
electrolysis. ) 

Tracings Nos. 117, 118, 119 and 120. Mr. C, age 
32 ; until quite recently subject to epilepsy. At the 
time of observation with the Sphygmograph he was 
suffering from acute enteritis. 

The amplitude of the tracings under all pressures is 
singular, as also its resemblance to the writings ob- 
tained in organic disease of the heart. There can, 
I think, however, be but little doubt that no regurgi- 
tation is indicated, but that whether we regard the 
many waves as due to oscillation or the presence of 
waves of recoil, the translation probably is that high 
arterial tension and some occult cerebral affection 
are indicated. 

The presence of a marked dicrotism in the tracings 
of epileptics is noticed by M. Voisin, in the Biennial 
Retrospect of the Sydenham Society, 1867-8, p. 471, 
but as the tracings themselves are not given, we can- 
not determine whether the waves were really those of 
the fourth event, of recoil, or of oscillation. An ap- 
parent verification of the opinion above expressed 
seems to be afforded by similar tracings among those 
of asthmatics which may be compared. 



THE SPHYGMOGRAPH. 123 

Tracing No. 121. Mrs. C, age 50. This patient 
came under observation for a chronic ovaritis of years 
standing. Examination of the whole body revealed 
no other active disease, but an impaired condition of 
one lung, due to a former disease, at the apex. 

The tracing under a pressure of 2° would suggest 
either degeneration of the arteries, of which no other 
evidence appeared, or of obstruction to circulation at 
or near the heart. Whether we ascribe it to the former 
or the latter, two things are certain ; there was obstruc- 
tion to free pulmonary circulation, as well as that 
which grew directly out of the congestion of the 
ovary, and as there was no evidence either of perverted 
inhibitory function influencing the capillaries, nor yet 
disease at the aortic orifice, which would probably 
have shown itself by a more sudden descent from the 
flattened apex of the tracing under the pressure re- 
corded ; and as moreover this kind of record is fre- 
quently met in local congestion, when not connected 
with too great inflammatory action, it is fair to at- 
tribute the appearance to the condition of obstruction 
indicated, viz : in the lung and in the ovary. Further 
inquiry and observation are necessary, however, to 
establish such a point satisfactorily. 

Tracing No. 122, is that of a young man age 35, 
suffering from chronic rheumatic arthritis, with de- 
posits in the joints of the fingers. The record was 



124 THE SPHYGMOGEAPH. 

made in the interval, between exacerbations of the 
disease ; the patient being able to attend to business, 
and the deposits comparatively insignificant. 

Tracings Nos. 123, 124, 125 and 126, are those of a lady 
age 26, suffering from metrorhagia after confinement. 
In forty-eight hours after the last tracing, the record 
gave a smooth even wave, the patient feeling free 
from faintness, &c. 

Tracings Nos. 127, 128, 129, 130 and 131, are those of a 
boy, age 6 years, suffering from acute Bright' s disease. 
The tracings were taken during the stage of anasarca, 
the boy presenting the peculiar waxy color, charac- 
teristic of organic disease of the kidneys. Since the 
last tracings, the progress toward recovery has been 
rapid, and is now almost complete. (Dec. 20, 1872.) 

The appearance of albumen and casts no longer 
exist in the urine, and the pulse is fast regaining its 
tone and fullness. On the first occasion, there will be 
noticed the interrupted efficiency of the heart, faintly 
simulating mitral regurgitation, together with the 
accentuation of the primary shock wave, or first event, 
and dicrotism under a pressure of 2°. On the next 
occasion, the predominence of oscillation in the blood 
current was singularly pronounced. On the next, 
and but three days later, a normal tracing appeared, 
(with exception of its frequency,) and under a 
normal degree of compressibility. 



THE SPHYGMOGRAPH. 125 

Tracings Nos. 132 to 146, inclusive, on the chart 
opposite, are those of a man, age 64, who for nearly a 
year had been suffering from gangrene of the foot, 
due as was supposed to degeneration of the arteries. 
In none of the tracings, however, was this apparent. 
Upon consultation, it was deemed advisable to remove 
the limb through the junction of the middle and 
lower third of the thigh. This was accordingly done, 
and the records exhibit the condition of the patient 
immediately before and after the operation. As may 
be inferred, his condition prior to the amputation was 
not particularly favorable, owing to the prolonged 
drain upon the system due to the nature and duration 
of the disease. 

Aside from the history exhibited by the tracings 
and the appended notes, it may be briefly said that 
for several days after the operation, no reparative effort 
of nature was visible, but by the seventh day a line 
of demarcation was well defined a few inches above 
the end of the stump, and the increase of appetite and 
strength gave promise of recovery. ~By the twentieth 
day, however, it became evident that age and pro- 
longed suffering had left no sufficient vitality to secure 
restoration to health, and he 'died of exhaustion on 
the twenty-eighth day after the operation. 

Two inferences seem to me justifiable in this case, 
viz : that the disease was not due to any atheromatous 



126 THE SPHYGMOGKAPH. 

or other degeneration of the arteries, becanse none 
such appeared in the Sphygmographic record, and 
that the operation was therefore justifiable on the part 
of the operating surgeon ; and second, that inasmuch 
as some local affection of the artery probably existed, 
the operation might have proved successful, if this 
could by any means have been ascertained, and the 
amputation made high enough above it. The line of 
demarcation and the total want of any reparative effort 
in the stump, seemed to show that by an accidental 
selection of the point of operation, the disease was 
left above instead of below it. 

These tracings exhibit greater varieties and better 
examples of the recording power of a Sphygmograph, 
than any given in this essay. The intermission shown 
in some of the tracings, and the prolonged fullness of 
artery, with oscillation and sudden collapse in others, 
are interesting. 

Tracings Nos. 147 and 148, (impaired arterial elas- 
ticity; the patient a frequent sufferer from acute 
rheumatism, with no discoverable cardiac lesion as 
yet ;) No. 149 and 150, (dilated heart ;) No. 151, (laryn- 
geal phthisis ;) are introduced because the records 
of cases of considerable interest, but of questionable 
diagnosis. They are believed to be due to the 
diseases, however, indicated. 
The first, for example (No. 147 and 148), was of a 



THE SPHYGMOGRAPH. 127 

man, age 55, who had been pronounced by various 
physicians to have both disease of heart and lungs. 
Subject to acnte inflammatory rheumatism up to 
within a year, he yet manifested no outward signs of 
cardiac disease, and a careful examination failed to 
detect any organic disease whatever. There exists, 
however, evident impairment of elasticity of arterial 
tissues, and the man uses tobacco to an injurious 
excess. 

Tracings Nos. 149 and 150 are tracings from a young 
female, exhibiting all the symptoms of dilated heart, 
and yet at times so free from them as to throw doubt 
upon so grave a diagnosis. The concurrence of several 
physicians, however, in the belief that such is the 
disease, and the careful observation of the patient for 
nearly two years, have appeared to warrant the belief 
that the diagnosis is correct. The case is of such 
variety in some respects, however, that it is unfor- 
tunate that it cannot be given in detail. 

Tracing No. 151 is from a young man with laryngeal 
phthisis, with slight disease at one apex (no softening). 



CHAPTER VII. 
PHTHISIS. 

The following tracings, Nos. 152 to 177, are those of 
cases of phthisis. Out of several hundred these alone 
are given, but the selection has been made to give as 
correct an idea as possible of the character of tracings 
usual under such circumstances. 

The first patient (Nos. 152 to 155 inclusive) was a 
young man, who, when seen in February, 1871. had 
become debilitated by about three month's illness; 
softening of deposits having commenced in the apices 
of both lungs. 

Treatment and general progress in the case are of a 
too familiar type, and need not be detailed. He was 
sent around the world, via Australia, and in March, 
1872, returned, only to show immediate signs of pro- 
gressing disease, which had apparently been quiescent 
while at sea. August 12, 1872, as stated in my notes, 
he had come to his bed, and suffered from hectic, 
night sweats, &c. August 24, 1872, he was cheerful 
and with good appetite, but failing rapidly, the pulse 
not bearing a pressure above 0° without obliteration. 
He died September 1, 1872. 



THE SPHYGMOGEAPH. 129 

Tracings Nos. 156 and 157 are the record of a young 
man, age 33, also with phthisis, but in a stage short of 
softening, the apex of one lung only affected, but the 
ary-epiglottic folds, showing the pyriform enlarge- 
ment, common in phthisis pulmonalis, and the 
patient a subject of haemoptysis. 

Tracings Nos. 158 and 159, are from females of 
about 30, with advanced disease of the apices of both 
lungs, although not yet confined to bed. Minute 
record of symptoms, &c, are not given in connection 
with any of these cases ; the object now in view being 
of too general a character. 

Tracings 160 and 161, are from a young man whose 
condition may be best described by simply copying the 
notes taken at the time of an examination, some time 
previous to any marked symptoms of illness, except 
haemoptysis. "Left lung — in front wavy, and inter- 
rupted inspiration and prolonged expiration, with dull- 
ness and absence of vesicular murmur as low down as 
the nipple. At the back, pronounced bronchial breath- 
ing above the scapula ; and over a spot three inches in 
diameter at and below the angle, vocal resonance. 
Dullness most marked over the upper portion of the 
thorax. No crepitation or rales. Inspiratory and 
expiratory sounds the same as in front. Right lung — 
sounds normal with exception of slight dullness over 
the posterior portion of the thorax below the scapula, 



130 THE SPHYGMOGKAPH. 

apparently the result of previous inflammatory action." 

The tracings given were taken after the beginning of 
softening, some months later ; all others being omitted 
because possessing no especial points of interest. 

Tracings Nos. 162 to 166, inclusive, are those of 
chronic phthisis. 

Cases 167-168, 169-170, 171, 172, 173, 174, 175, 176 
and 177, are of latent phthisis, the predominant 
feature being often entirely unconnected with the 
affection of the lungs. The pathological indications 
in all cases of phthisis, however, excluding of course 
the variation due to degenerations of tissue, and inter- 
current diseases, may be briefly stated to be those of 
weak heart and atonic capillaries. These will be 
found especially prominent in cases complicated with 
haemoptysis. 

Aneurism, (see records, Part III.) The tracings 
of aneurism are usually what theory woidd lead 
Us to expect, and the thrill perceptible to the touch 
at an advanced stage is simply anticipated at an 
earlier period by the Sphygmograph. 

The tracings Nos. 178 to 180, inclusive, are presented 
in connection with each other under, this head, simply 
to show the value of the instrument in diagnosis. The 
first tracing, 178, was taken from a man, age 50, with 
an immense aneurism of the subclavian artery, and 
although taken over the aneurism, which projected as 



THE SPHYGMOGEAPH. 131 

a swelling above the clavicle, it is a fair sample, mag- 
nified, of those from the radial artery. The patient 
was vigorous and free from other diseases, and, as in 
most or many cases of aneurism, was by no means 
convinced of the dangerous nature of his disease, nor 
assured by any unanimity on the part of the phy- 
sicians who had seen him. Indeed there existed the 
widest difference of opinion as to the character and 
source of the swelling above the clavicle. A sudden 
death and autopsy, however, corroborated the evident 
testimony of the Sphygmograph. 

This case may be compared with advantage with the 
two that follow it, Nos. 179 and 180. The first of 
these latter (179,) possesses considerable interest in 
this connection, chiefly because believed to be a case 
of subclavian aneurism up to the period of autopsy. 
No less distinguished a personage than Dr. Valentine 
Mott, 30 years ago, confidently decided that an aneur- 
ism ; existed and although of late years only a dense 
swelling, with heaving and not distensile pulsation 
has existed, presenting itself just above the clavicle, 
yet no question seems to have arisen regarding the 
original diagnosis. The Sphygmographic tracings, 
however, failed to verify this, as may be seen (No. 
179,) and at the autopsy the subclavian was found 
healthy, an exostosis on the first rib having given rise 
to the error by pushing upward the vessel in its growth. 



132 THE SPHYGMOGRAPH. 

Tracing No. 180, also a case mistaken for aneurism, 
was one of considerable interest, and may be briefly 
described. The patient, a man of about 50 years of 
age, presented himself for sympathy and pecuniary 
aid, and showed a certificate signed by several promi- 
nent physicians of a well known hospital in New 
York, to the effect that he had an enormous aneurism 
of the abdominal aorta. In spite of this appearance 
of authority, however, a very careful examination 
failed to furnish to my mind sufficient evidence of 
any such trouble, and while not able to substitute 
satisfactorily any other diagnosis, the Sphygmo- 
graphic tracings taken from various arteries of the 
body strengthened the unbelief, and the man was 
dismissed as an impostor. This opinion was subse- 
quently verified by his arrest by other parties and 
confession. The tracing, as may be seen, shows de- 
parture from health because of dissimilarity in the 
successive waves, but not suggestive of aneurism. 



PART III. 

CHAPTER I . 

INVESTIGATIONS MADE WITH THE SPHYGMOGRAPH INTO THE ACTION 
OP CERTAIN MEDICINES UPON A HEALTHY PULSE. 

It will be evident to any one, upon reflection, that 
with all remedies there may be an action upon the 
system at large, or npon the circulation, prior to its 
sensible and. familiar action. If this be really the 
case, the Sphygmograph would discover ' it with a 
measurable degree of certainty. We may also reason- 
ably look for certain other actions, too slight in degree 
to be perceptible to any perhaps but the patient, yet 
of such a nature as to afford valuable guides to the 
exhibition of the drugs. It is not improbable, more- 
over, that the action of certain poisonous remedies 
might be so perfectly recorded by the aid of the 
Sphygmograph as to afford a means of diagnosis in 
cases of poisoning, or be the measure of the chances 
of the patient. It is at any rate certain, that by it we 
may determine the first moment at which the system 
feels the effect of the substance administered, whether 
it primarily affect the circulatory or the nervous 
system, or both, and ascertain by the determination of 



134 THE SPHYGMOGRAPH. 

predominance of pressure in arteries or veins, the 
possible effect of a remedy upon a condition of stasis 
in either. 

The physiological and pathological indications in 
this direction are important and interesting, and the 
tracings, which have been taken with great care, are 
given in detail. 

Four drags have been selected for the experiments, 
of known purity and freshness, and in each instance 
with the exception to be noted, the first tracing was 
taken and the first dose of the drug also at 9 P. M., 
always at least 2| or 3 hours after the last meal of the 
day. The observations • were made upon my own 
pulse, and as a comment upon the facility with which 
the instrument can be used, the tracings, in every 
instance, were made by myself. 

The experiments with the first drug, Cannabis 
Indica, are given with minuteness of detail, as illus- 
trative of the manner of making the observations, but 
the subsequent ones will be treated more briefly. 



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<X> 




ffi 


& 02 


CD 

■H-3 

co 






HH 






<HrH 




co 


o e3 


/■ — - 


pj 


£ 






=H — 1 

o 




bp 


■a £ 


os 


O 


H 


O 




co 




c3 


1 o 


• H 


rH 


-1-3 


£ 
w 

a 


Eh 
3 


<M 


So 

CD 




H 


1 ° 


o 

°-4-3 


bJO 

$3 




1— 1 

Ph- 


P3 


CO 




N 


>> pi 

O CO 


CD 


H 


s 

CO 


M 


Z 


Ci 


EH 




Ph' 

IO 


d °2 


CO 
O 


s 1 


CD 
CO 






a 

o 


o 




d 
c3 


S C3 

bC ^ 
• 3 £ 


1 

■S 9- 

CD 5 


Ph' 
o 

CO 


of d 
co o 

CD .Pi 
i — 1 -M 


i— i 






o 




O 






d 








OS 




tH 






rH 





142 



THE SPHYGMOGKAPH. 













S(-H 




CD 


o 




CD 


b0 












© i 


O 




CD 


cp! 


6 


rd 


p 












+3 


-4-= 
Pi 




eft 


•i— i 


«« 


+3 


CD 














CD 






CD 




«r-l 


s 03 

en 

"d 

o3 






CO 

O 

<< 






CD 
+3 
CS 

Si 


a 

ft 
B 




CD 
«.02 
e*H 

Pi 
<3 


EH 


CO 

a 

CD 


o 

5JD 

.2 


CO 
CO 




CO 

M 

o 












o 




""cD 


o3 


CD 


1' 

•§ 

6 


5K 

o 




M 

o 

CO 


o 

PI 

-1-3 




cd" 

P 

o 

&J0 


CO 

CM 

tH 


CO 

bJO 


CO 


'3 
O 

CO 

.a 


CO 
CO 

CD 


<! 

o 

3 
o 

o 

CO 

W 

Ph 


"co 

CO 
ft 




1 


pi 
6? 




CO 

co 

CD 

.s 

'co 


o 

CD 




O 
CO 

c3 


o 

CD 

-2' 


1 

O 

G 
to 

CD 


o 
id 




id 


o 

f-H 

h 


^ 


O 

P 
id 


S 

o 

eft 


CD 
CD 

'o 
X 

CD 


CO 

Pi 
O 

CO 

Pi 

CD 
CO 


p. 

rd~ 

CD 


"c8 

CD 

ft 

CO 
CD 

^d 

ew 

O 


3 




© 




T-H 

T— 1 






tH 












•4 

to 




























d 




^-^ 


o 


Pi 
CD 


CD 


«H 


r* 








to 




CD 




: 


ce 




o 


CD 










o 




CD 




<M 


^3 


CD 


H 


CD 
OQ 

c3 

CD 

o 

CD 

^d 
Pi 

CD 

^d 

rd 


^d 

rd 












CO 

O 


O 
rH 

CD 
-t-= 

'3 




d 

c 
o 

CO 

tp 


c3 

w 

o 

CO 
CO 

CD 

ly] 

e3 

1 

-^ 
e3 
CD 

bJD 

■d 
03 
+3 


CD 

+3 

1 


CM 
O 
CM 

_P 
"o 
o3 


CO 
CD 










s 

a. 


H 

CO 

M 

O 

«! 

EH 

H 

a 

A 

EH 


CD 

o 

CO 
,CD 

CO 


P 

a 

r* 
+: 


"o 

EH 

fin' 


1 

'cd 


EH 

o 

r-5 

tH 


CO 

c3 

rd 

CD 

O 
CO 

Pi 

CD 


^d 
o3 

PI 

.2 

'co 

Pi 

CD 
-4-3 

o3 












i 


£ 


0. 

;_ 


? 


M 


rQ 


P 


M 
















c 


tH 


OJ 


■+3 


<3 


£ 


^ 














a 




fd 


co 




00 


CO 

>d 


o 

p 

CD 


CD 
CO 

c3 












P 




o 


CD o 


tH 


?H 


d 


CD 










p4 

lO 


- 

5 


3 


o 

CD 


£ c 

o ^ 




o 
o 

CD 


a-* 

CD 


O 










o 




rH 






tH 
















tH 




1—1 






iH 













THE SPHYGMOGKAPH. 



143 

































-+-3 




cT 










CD 


c 

o 




CD 




■ rH 










~ 


"^ 




H 










ew 


p 


















O 


"3 

cc 




rd 




CO 










'■0 




<3 

ft 
CD 


o 


P 


co 








o 
c3 


r~ 




&J0 


bb 


CD 

-1-3 
P 

P 








X 




CD 


°CO 


CD 
C70 








•§ 




6 


Pi 


co 

ft 

CD 

a 


CD 


1 








o 

0) 


P 

■ a 


§ 


CD 
CD 


-1-3 


o 








Ph 


(X 


CD 


CD 
t> 

W 

■d 

CO 


Pi 
CD 


P 

o 

1 

■+= 

o 










o 


(X 

p 


q-i 

' o 

Pi 

.2 

"Eq 
P 


<Pi 
CD 

+3 


co 
O 

rP 

CM 








}> 






i—i 




Eh 






03 




^ 






bJD 


c3 
-4-3 










(3 






Pi 








'op 




CD 






% 


£ 








'$■ 










O 


'<£ 








o 




bC 






CO 


b 








Jo 




£ 






■+= 


c3 






* 






O 






^ 


-H 








r& 




co 








'& 








03 




"3 






of 


c3 

o 








PI 




3 






CO 


"o 




















rH 








c3 




'cS 








P 

co 












Pj 

CO 
















bo 








CO 


H-3 

o 


















o 


fH 








o 


bb 


bO 
'3 






CM 

be 


o 

4-3 








J 


-5 


c3 








M 








© 


03 


Eh 






£ 


r — 1 

co 








03 


+J 










CD 








^2 


5H 

o 


a 


■+- 






s3 








o 


03 



o 


a 




o 

CO 

CO* 

rH 


O 
co 


3 







144 



THE SPHYGMOGRAPH. 







V 


JO 










•1 










•to 




















o 

H 

ft 
6h 


5? 


•1 










is 


CO 






p 






CO 








^2 


•1 








g 




5s 








Q> 


o 

CO 




>* 




1 


*to 










<CS 
IS 

Co 








O 

p! 

OS 


i 






CD 




o 
.pi 


C^ 


p 
3 


M 

ft 




ft 

B 

c5 


.2 




CO 

g3 
03 




§ 


CO 

3 










"to 




O 




o 




P3 


« 




3 


£ 




-+J 


.s 




e*H 


1 




£ 

g 


-(-3 

CO 
^3 


s 




O 


rd 




o 

+3 


rd 

c3 


w 


8 


cp 






CD 


03 


o3 




CD 


3 


w 

EH 


p 


u* 
® 

«£ 


'o3 


Pi 


co 
c3 
03 
Fh 
C3 


o 
Pi 
.2 


. 03 

a 
PI 
c3 


o 

03 


ft 


o 

co 
H 
Pi 
O 


o 


Q 


rd 
03 


05 

O 


pi 

c3 


■ r-l 






a< 


Pj 


Eh 

o 


EH 


co 


03 


PI 


+3 


co 

CO 
CD 


-+-3 

co 


03 

43 


O 


o 


fc 


"3 


)y< 


c 


'E 


o 


^3 


rd 


bC 


^ 


H 

fe 
fe 


E- 
D 
H 
ft 

ft 


^3 




-(J 


c 


PI 


2 


03 

CO 

03 


'3 


bJO 


o 

GO 

1— 1 
GO 


2 

K 


03 

o 


of 

cd 

s 

io 

03 
43 


CO 

O 

.s 

rd 

CD 


CD 
03 

PI 

C3 


CO 

of 

03 

+3 


c3 

o 

co" 

CD 


_-+-3 


'be 

03 
co" 

3 


.3 ^ 

-+3 rrj 
PI 03 

oT rt 

CO tH 


Ph 

o 


E« 
H 




n 


03 


o 


JO 


o 

'co 


o 


7^ ° 
ft PI 




£ 


03 


+= 


JO 


CO 


0J 


PI 

r- 1 


.§ '-§ 


m 
























g 






















| 






















I 












id 










1 g; 


o 










r-l 










S ? 


T— 1 




















S w 












© 










Hg 


OS 










T-i 










fc ft 


m 
Pi 










PI 










*H 












"-H 










8 

o 

p 


'eg 

3d 
jo 










be 









THE SPHYGMOGRAPH. 



145 





JO 
CO 






JO 

CO 






T-H 


CO 

CD 






JO 




•2 


T-H 


CO 

CD 




.s 






s-a 






5si 


■+-> 






O 






8 

•Si 


















o 














52 








0Q 
CD 






co 

CD 




'to 


JO 




S 


i— 1 


CO* 


O 


JO 




5: 


— 




*?" 


2 




^ 


f_l 




•<s> 


<5 


£ 




f_4 










■S 






*s 


2 




^ 




"s 




o 




& 


M 




o^ 


~ 




& 








5^ 




fe> 
















^ 


=t-H 




, 


. 




CO 


CD 














C^- 




3 

"to 


o 




=H 


>, 




CD 
O 


O 














__i 






o 


(-H 


Cj | 






CD 


co 














CD 
CO 




•+3 

.9 


CD 

p 


.2 

'-£> 


O 

CD 
CO 
CO 

CD 


CO 

co 

CO 


S 

'co 


CD 
CD 
CO 


"^ 


CD 












5 






Ph 


g 


o 


fcD 


CD 


o 

H3 


3 


CD 












"' 




cl 




co 


■S 


•S 


!-;-{ 


-1-3 


CD 


^ 








.2 

'co 




m 
O 

to 


~cl 

CD 

So 


5d 

CD 

co 


CO 

co 

CD 

a 


'd 

'Pn 
co 

6 


-+■3 
CD 

5b 

co 

CD 


co 

-1-3 

CO 


CD 
O 

CD 


co 

S 
O 


2 

<^ 
O 


O 
CD 

-+3 

CO 

§ 








CD 
02 

co 

CD 

o 

.9 

CO 

.9 




efl 


o 

°co 


CD 


•9 


,5 


-1-3 


CD 


s 


CE 
CD 


p 










O 


CD 

-1-3 


.9 


"^ 


CD 

CD 

O 


'1 


o 

CO 

o 


CD*"' 


~£ 




Ph 

CD 










co 

0) 


^ 
l 

d 


o 

CO 


o 

CD 


bJO 

O 
Id 


JO 

CO 


-1-3 

CD 


O 
co 

CD 

-1-3 


JO 
cl 


CD 

CO 
CO 

CD 


-(-3 

'CD 

3 

+3 








o 




fl 


^ 


pi 


CD 


„ 


^ 


£ 


J3 




o 










5 


o 

CD 


O 




CO 
CD 
> 


c 


o 

CD 


CD 


O 


o 


co 








CO 




pj 


T— 1 




co 


i— 1 


pj 


t> 


tH 


q-H 


^ 








£ 




£J 


C7 1 


fl 


co 


rt 


OH 


<£ 


rn 


o 


O 








1 — 1 




M 




hH 






1— 1 






HH 










H 

£ 


En 




1 

CD 










1 

CD 
















w 






O 










o 
















g 

K 


o 


^ 


£j 










a 
















S" 


co 




CO 










co 
















W 


p. Ph 


i~< 










Ph 


















O 


o 


C 


id 








O 


JO 














o 


nc) 


— 1 


^ 








^ 


o 














H 




ai 




ci 










T-H 














OQ 


o 

CO 




o 










o 
























10 























146 



THE SPHYGMOGRAPH. 





Eh 

H 


§ * 9 

■+= d th 

CO S _^ 


d ° 
d jxj 

rr-T ° 

d !H 


d 
1 

JO 
CM 


Maximum of seda- 
tive effect in 12 
minutes. 




ration in 
iment 45 
1st dose. 




a 
a 


I'll 


O O 

O 

m g 
S d 

o S 


d 

•r-H 

CD 




3 & 2 
®.2 d 

^ .d 'd 

o 53 a 


















W 


C 














H 


. -<S> 














o 

•4 


• ■+ 3 cd 

d "g 














s 














-4 


. CD 












1 


w 
o 

m 

E- 


+3 C3 












1 

1 




• "^ d 

© P 
. i— 1 ^ 






a 






CO 


« 


« o 






rtf 






H 


fi 






d 






O 


H 
Eh 


" & ^ 






03 






fa 
fa 


CO cp 

^ d £ 

03 « 'H 


"8* 

CD 




CO 

CO 
CD 






fa 
fa 

o 


O 

H 
O 

w 


05 d ii 

d d d 

rd r ^ 


J 




d 
"to 




"§ 


CO 




r_l CO 


a 




o 




.1—1 

d 


CO 


>j 


CD 




^ 




o< 


PU 
O 

P 

co 


D 

3 

o 

o 


I ! I 


erf 
CD 

■+3 




of 

% 




1 


S3 


d .3 d 


S 




d 




d 




H 
















(5 • 


H i 


"s 




'1 




"a 






8 « S 


JO 




JO 




o 




CM 




Oi 




CO 




& 


d d p) 


d 




d 




d 






M •— • 1— 1 


HI 




HI 




i— i 














1 


Eh • 




J. ^ 

9 a 
H S 
o g 










a 


«w 




id 

rl 

as' 


rl 

d 








o • 




ad 


T— 1 






p 


P JO 




< fA 










H 


'I T— 1 




w 


Sb 


QQ 






O 

9 

m 


OS 




P 


JO 








m 


o 

CO 



THE SPHYGMOGEAPH. 



147 





o 

r3 


O 




q-L 

cS 

_5 


© 

O 


QQ 

CD 


CO 






q-n 

O 

g 


r-i 




— 

K 

K 


o 


•4-i 

.-9 


CD 

'm 
O 


02 
pi 




g 


02 

02 




ji 


© 
02 


o 






- — 


CD 




% 




CM 


rrt 


§ 




e3 


"qq 




© 


© 






CO 




£ 






^ 






o 










4§ 




































o 


















M 


















cd 


















| 






















































1—1 


















„ 


















o 


















ac 


















O 


















n3 


















^ 


















^> 












.2 






50 








02 
m 

CD 

p) 








CO 

02 


*H 








'02 




'•Th 




o 


CD 

•4-3 








fc 




X 




"02 


c5 








O 




© 




£ 


to 








fd 




af 




p 


CD 
■4-= 








of 

CD 




-^ 














■4-3 








































£3 




r-l 


°^H 








fl 






















"a 




o 




-^ 






"i 




JQ 




r ~ 1 


©3 


P 






o 




xH 




tH 


a 






CO 




fl 




S 


PJ 






r^ 




1— 1 




I— I 


M 








1— 1 




























I 








c5 










© 








fl 










o 

s 


















co 


















ft 

O 








02 

ft 
O 


id 








rrt 


IT 








CM 










Tt 






""d 


© 








© 


cr 






© 


rH 








xH 








rj) 





148 THE SPHYGMOGRAPH. 

Synopsis of the two later experiments with Canna- 
bis Indica need not be given. It may be briefly said of 
them, that the doses were large and repeated at nearly 
one hour intervals. The effect was in the first of these 
apparent in the tracing in ten minutes, and a steady 
diminution of frequency resulted, until in 45 minutes 
there occurred evidence of implication of the nervous 
system. In 35 minutes after the second dose there 
appeared evidence of some obstruction to circulation, 
either near the heart or in the capillaries, and after 
420 drops had been taken the arterial tension was 
greatly reduced, with corresponding increase of the 
venous pressure, and marked sedation just two hours 
and fifteen minutes from the first dose, and thirty from 
the last and largest. 

Finally sudden cessation of effect. 

In the last experiment detailed, in which a fresh 
alcoholic extract was again used, the following facts 
were noticed : 

1st. — Tracings abnormal from malaise at the begin- 
ning became normal in forty minutes, with marked 
sedation and diminished frequency. In fifty-five min- 
utes began the stage of exhilaration, at which time a 
larger dose was taken. After fifty-five minutes the 
heart's impulsive power was evidently weakened, and 
shortly after began a vacillation both of equilibrium 
of pressure and frequency. 



THE SPHYGMOGEAPH. 149 

In one hour and forty-five minutes the nervous 
system was broken down by the excitement of re- 
action, a state ■ lasting for twelve hours. 






CHAPTER II 



EXPERIMENTS WITH GELSEMINUM. 



It would be tedious and unnecessary to give the 
minute details of the experiments made with the 
remaining remedies. 

In brief, these were Gelseminum Sempervirens, 
Aconitum Napellus, and Quinhe Sulphas. 

The first, the tracings illustrative of which are given 
(JSTos. 204 to 209 inclusive), were with reference to 
the action of Gelseminum Sempervirens : 

At 9.00 P. M. Six drops of Tilden' s fluid extract were 

taken. 
At 9.30 P. M. Being slightly drowsy, six drops more. 
At 10.00 P. M. Ten drops more, with the following re- 
sult : — 10.15. A heavy feeling in the 
ears, and sense of weight over the 
forehead. 
10.20 P. M. A peculiar sense of constriction at the 

base of the tongue. 
10.40 P. M. Drowsiness increasing. 
10.55 P. M. Peculiar slowness of respiration— 7 to 
the minute. 



THE SPHYGMOGEAPH. 151 

11.05 P. M. Disappearance of all effects. 

11.25 P. M. Sense of giddiness. 

11.35 P. M. Free from all sensible effects. 

This drag lias been selected for experiment for the 
two-fold reason that difference of opinion as to its 
action has existed among medical men, and that a 
somewhat large personal experience with it enables 
me to speak of it with some familiarity. This experi- 
ence has been favorable in puerperal eclampsia and the 
convulsive disorders of children, the neuralgic and 
congestive affections of the uterus or ovaries, and par- 
ticularly in cardiac and pulmonary' diseases, where 
sedation and reduction in frequency of pulse have 
been desired. With reference to its action in the 
latter respect, the tracings will be found instructive ; 
and in view of the unfavorable opinion expressed by 
Da Costa (Am. Jour. Med. Sc. 1871) as to its action in 
irritable heart, they will probably be also interesting. 
In his hands, reduction of impulse and frequency were 
so slight as to be unimportant. 

The tracings given may be compared profitably with 
those of Aconite, which succeed. 

It is a fact worthy of notice, although already 
referred to, that in this case, as in many others, the 
Sphygmograph shows the action of the remedy often 
long prior to the exhibition of any sensible or physio- 
logical effect. 






152 THE SPHYGMOGRAPH. 

This, in the present instance, is made the more 
noticeable by the fact that at the beginning of the 
experiment the pulse was not perfectly normal, owing 
to fatigue, excitement, and loss of rest. 

With regard to the dose used, a word is necessary. 
Having frequently observed the toxic action of the 
drug, even to ptosis, roaring in the ears, &c, after 
giving three drops of the fluid extract at intervals of 
half an hour, this fact of personal experience has been 
in mind throughout the experiment ; — as with Can- 
nabis Indica I was myself the subject in the case. 

On the 12th of November, at 9 P. M., six drops were 
taken ; at 9.30, six drops more ; and at 10 o'clock, ten 
drops. The results, which were as follows, are also 
indicated on the chart. 

Not being perfectly well, there existed either a 
recoil or dicrotic wave in the preliminary tracing, 
which in 30 minutes seemed rather to become more 
prominent, and but for the records that follow, 
might be at once set down as a true dicrotous wave. 
As at this time there will also be seen diminution 
of compressibility, as shown by diminished amplitude 
under the same pressure, the prominence of the 
waves, whatever its explanation, must be ascribed to 
a morbid condition, viz : that produced by the influence 
of the poison administered. The pulse at this interval 
has reached a minimum as to frequency, and in ten 



THE SPHYGMOGKAPH. 153 

minutes more shows slight impairment of rhythm. 
The new dose of ten drops exhibits its first influence 
in the tracing in 30 minutes, by increased arterial ten- 
sion and nervous stimulation, followed however in five 
minutes by diminution of both, and great decrease in 
frequency. From this time on to the end of an hour, 
the tension in the arterial system slowly increased, 
although the frequency remained nearly the same, and 
after one hour and a half the appearance of some 
obstruction as shown in the flattening of the conjoined 
apices of the first and second events was manifest, 
and irregularity of impulse and of rhythm exhibited 
the effect of the poison upon the heart. 

Neither of the effects tast named could have been 
perceived by any other means than the Sphygmo- 
graph ; and at this time the sensible action of the 
medicine had disappeared. 

The simple deduction from this investigation, apart 
from what is already known of the remedy, lies in this 
— that while reducing the frequency of the pulse, it 
does so with an increase of arterial tension, and after 
a while impairment of the heart's action, indicating a 
toxic influence upon the nervous system. 

It is therefore not surprising that singularly incom - 
patible experiences have been recorded by different 
physicians. 



CHAPTER III. 



EXPERIMENTS WITH ACONITE. 



The third experiment * was made November 14, 1872, 
with a fluid extract of Aconite root, npon a young 
lady perfectly well, as far as could be ascertained, and 
aged eighteen years. 

A pressure of 2° was found the most available, and 
was, as in all these later investigations, maintained 
throughout : tension being ascertained by amplitude, 
as already described in the preceding pages. The 
oscillation evident in the first tracing was simply the 
result of nervous tremor. 

This 3 r oung lady took four drops in all, 1 at 1.50 
P. M., one at 2.20, and two at 2.45. In twenty-five min- 
utes from the first dose occurred the first effect in the 
tracing ; reduction of frequency and force, there being 
no physiological influence perceptible. In jive min- 
utes more occurred a sudden increase of both, without 
apparent cause, although from the fact that the tracing 
shows slowness of collapse of the artery, it may have 



Tracings 209 to 213 inclusive. 



THE SPHYGMOGEAPH. 155 

arisen from capillary constriction due to the direct 
stimulus of the impelled current against them. In 
five minutes more this has disappeared, and in forty 
from the administration of the first dose, the force, 
frequency and arterial tension have reached a minimum 
without any perceptible physiological effect being 
experienced. 

The new dose shows itself in twenty minutes instead 
of twenty -five, as with the first, and two drops addi- 
tional were taken. 

In thirty minutes thereafter, the pulse-writing being 
almost a straight line, and having thus exhibited the 
maximum effect of the remedy in a minimum of ten- 
sion, force, frequency and complete disappearance of 
all evidences of nervous or other excitement, tlie first 
appearance of any sensible effect occurred in a simple 
dizziness upon exertion. 

Aconite continued — larger doses. 

The next experiment was made November 14, 1872, 
upon myself, with a fresh fluid extract of Aconite root, 
and its effects were briefly as follows (tracings 214 to 
221 inclusive) : 

The first effect visible in the tracing occurred in 
fourteen minutes, viz., diminished frequency ; and in 
three minutes more, or seventeen from the taking of 



156 THE SPHYGMOGEAPH. 

the remedy, a great increase of arterial tension, with 
prominence of the wave of recoil. 

After thirty minutes this was slightly less, and the 
first physiological or sensible effect occurred in a sen- 
sation of fullness of the carotids. 

The maximum of nervous excitement and increased 
tension is visible at 9.45, or 35 minutes after the dose, 
followed by reaction and minimum of frequency, and 
tension at 10. 

With the next dose the maximum, showing the stage 
of excitement due to the remedy, occurs in thirty min- 
utes. The reaction, or minimum of force, frequency 
and tension, and showing sedative influence, occurs 
ten minutes later. In fifty minutes a feeling of faint- 
ness occurred, not however indicated in the tracing, 
and therefore, probabty, a reflex phenomenon due to 
the condition of the stomach. 

In one hour and twenty minutes, when the true 
physiological effects of the remedy were shown, as 
stated on the chart, a great increase of frequency and 
arterial tension with cerebral excitement were manifest, 
followed however by reaction and variations in the 
pulse-wave, until at twelve o' clock the long even wave 
of health is given, even under a pressure of 5°, and 
all sensible effects had passed away. 

The deduction from these experiments is of special 
interest, and we may compare it with a degree of cer- 



THE SPHYGMOGRAPH. 157 

tainty eminently satisfactory with that of Gelseminmn. 

Leaving out all other considerations, we have this 
one fact apparent, that Aconite unlike Gelseminum, 
while primarily showing a stage of excitement, yet 
reduces the heart's action as to frequency of beat 
without increasing arterial tension. 

The application of this fact to pathology will be 
evident. 



CHAPTER IV 



EXPERIMENTS WITH QUININE. 



Two experiments with this drug are presented, 
showing the effects of single large doses, and of fre- 
quently-repeated smaller ones. The deductions, in 
brief, are as follows : 

First. November 16th (tracings 222 to 225 inclusive). 
Being especially sensitive to the tonic action of qui- 
nine, and moreover very susceptible to the influence 
of substances having a bitter taste, when taken simply 
into the mouth, the first dose taken was but half a 
grain, dry, upon the tongue. Its action when thus 
administered cannot be mistaken as affecting the cir- 
culation ; a lessened frequency, increased tension, and 
developed vibratile character, were apparent in fifteen 
minutes, no sensible effects of course being manifest. 

At this time, the pulse being 64 per minute, ten 
grains were taken. 

The above-named features (tracing 226) were magni- 
fied, and reached a maximum in twenty-five minutes 
after the large dose, and in thirty minutes occurred the 



THE SPHYGMOGRAPH. 159 

minimum of tension, with, however, increased fre- 
quency, and after that a variation of both within a 
very brief interval. 

The only inference from this experiment, relates to 
the stimulant and sedative properties of quinine upon 
the nervous and circulatory system. 

Quinine continued — small and repeated doses. 

November 18, 1872 (tracings 227 to 233 inclusive). 

On this occasion two grains of the sulphate were 
taken every ten minutes up to sixteen grains, with the 
effects perceived in the tracings, beginning at 10 
o'clock P. M. On this evening, as shown by the pre- 
liminary tracing, there existed the fatigue and slight 
excitement due to the arduous work of the day just 
closed. 

At 10 P. M., first dose of two grains. 

In seven minutes occurred diminished frequency. 
In twenty-three this had reached a maximum, the 
tension being slightly increased, as shown by the 
transmission of the alternate waves. 

A sedative influence, both nervous and circulatory, 
became apparent at 11.30, and existed until 12 o'clock, 
when the influence upon the nervous system is shown 
by the peculiar shape of the primary wave and the 
delayed collapse of the artery (231). 

From this hour, when a feeling of tension in the back 



160 THE SPHYGMOGRAPH. 

of the head was noticed, the excitement of the nervous 
system increased, and is thus described in my notes 
made the following day : 

"Unsound and troubled sleep; nervous jactitation 
and twitching ; stuffed sensation in the head, and fre- 
quent desire to micturate, with painful vesical spasm 
after each attempt — and heavy deposit of phosphates ; 
pain in the bowels ; and severe neuralgic or congestive 
pain under the left nipple, lasting all night. 

' ' Awoke with all the sensations common to a man 
after a night of dissipation and excess. Feeling of 
twitching all over the body, with no apparent or actual 
trembling ; dull heaviness in the ears and back of the 
head, with pulse of 96." 

At 8.30 P. M. tracings were taken (232) which ex- 
hibited all the feelings above described as graphically 
as they were experienced. 

The oscillation here evident furnishes an interesting 
comment to the rules relative to this feature, given on 
page 73. 

The deductions from this experiment, aside from 
what is already familiar, in conjunction with the action 
of quinine, relate chiefly to the influence upon the 
frequency of the pulse and the state of the nervous 
system, the effect of large and small doses, and the 
moment at which their action begins. 

Reference need not be made in this connection to the 



THE SPHYGMOGRAPH. 161 

experiments with ordinary means of observation by 
others — detailed in the many periodicals of the day — 
as it is presumed that its singularly diversified actions 
under different circumstances are familiar, but the 
facility with which observation may be stamped as 
accurate or otherwise by the Sphygmographic record, 
is suggested by the examples here given. 



CHAPTER V. 



REMARKS IN CONCLUSION. 



To attempt in any perfect manner to epitomize the 
indications afforded by the Sphygmograph in the 
numerous examples presented, would prove a serious 
task, especially as deeper meaning probably lies in the 
tracings than has yet been revealed ; but if the reader 
will bestow the requisite amount of patience upon their 
study the appearance of similarity will vanish, and 
assurance that both the pathological and physiological 
indications afforded by the instrument are of great 
importance, will seem well founded. 

What we have endeavored to show, by the some- 
what diffuse exposition of the subject, may, however, 
be thus briefly summed up. 

First. That the new principle in the construction of 
the instrument exhibits a new and wider field as within 
its scope. 

Second. The value of a knowledge of the minute 
peculiarities of the arterial current, in connection with 
the determination of the condition of both the vascular 
and nervous system. 



THE SPHYOM0GRAPH. 163 

(Under this head have been considered the condition 
of the heart as to vigor or irritability, character of 
impulse, duration of systole, hypertrophy eccentric or 
concentric, condition of the valves, etc. ; the relative 
tension in arteries or veins ; the condition of the former 
as to contractility, passive dilatation, degeneration, 
etc. ; and also the physiological inferences educed 
under the action of medicines.) 

Third. The power of the Spliygmo graph to develope 
this knowledge, and correctly record it. 

(Under this have been considered the significance of 
each part of a tracing, so far as heretofore described, 
and also new features drawn from personal experience, 
substantiated by examples. 

Studies of tracings and numerous cases have been 
presented, that the student desirous of forming his own 
conclusions may do so.) 



INDEX. 



PAGE 

Aconite, ........... 154 

Action of Medicines, 45, 71, 133, 150 

Acute Enteritis, 122 

Amputation, Influence of, 56, 70, 98 

Aneurism, 48, 56, 70 

Anger, Influence of, 93 

Aortic Pulsation, 97 

Arterial Tension, 79 

Arterial Waves, 38 

Artery, Artificial Obstruction of, ..... 84 

Arthritis, Rheumatic, 123 

Artificial Heart, . . 59 

Asthma, with Bronchitis, 115, 116, 117 

with Disease of Heart or Kidneys, . . . . 116 

with Emphysema, . . . . . . . .115 

without Complication, . . . . 115, 116, 117 

Bronchitis. See "Asthma with. 1 ' 

Bright' s Disease, 124 

Cancer, 122 

Cannabis Indica, 135 

Cardiac Waye, . . 39 

Cardiac Disease. See "Heart." 

Carotid Tracings, 75 

Cautions, • 90 



166 INDEX. 

PAGE 

Chinese Views of the Pulse, 33 

Chronic Ovaritis, 94, 123 

Compressibility, * . . 64, 79, 84, 85 

Congestive Chill, . ■ 121 

Corrigan, Dr., 65 

Da Costa's Diagnosis by the Pulse, 36 

Debility, 99 

Degree of Pressure required, 27, 28 

Delirium Tremens, 58 

Deranged Sympathetic, 97 

Description of Instruments, 18 

Dial, 26 

Diarrhasa, 

Diagnosis, Cases for, 121 

Diastolic Wave, 54 

Dicrotism Explained, 58 

Disease of Sympathetic System, 97 

Lungs, 128 

the Heart, . . . .48, 49, 55, 58, 101, 126, 127 

Spinal Cord 117 

Dissipation, 114 

Duration of Impulse, 34 

Effect of Artificial Obstruction of Circulation, .... 84 

Emotion, Effect of, . . 93 

Emphysema. See " Asthma -with." 

Enlargement of the Heart, lOietseq. 

Enteritis, 122 

Epilepsy, Case and Tracing, . . 46, 122, and Chart opp. p. 44 

Exciting News, Effects of, 93 

Experiments with Medicines, .... . 133 



INDEX. 167 

PAGE 

Faintness, 92 

Fatigue. See first Tracing in Final Experiment with Cannabis 
Indica. 

Fourth Event, 54 

Frequency of Pulse, 85 

Full Meal, 93 

Functional Derangement of Nervous System, ... 92, 93 

Functional Disease of the Heart. See Chap, on Dis. of the Heart, 101 

Gangrena Senilis, . . . . . . . . .125 

Gelseminum, Effects of, 150 

Haemoptysis, Recent and Remote, .... 94, 95, 128 

Health, Variations Compatible with, 91 

Heart. See " Disease of the Heart." 

Hemorrhage after Confinement, 46, 70, 124 

Hysteria, 46, 96, 99 

Kidneys, Disease of, 124 

Laryngeal Phthisis, 126, 127 

Lifting Power of the Arteries, . . . . 23 

Locomotion of Arteries, 64 

Locomotor Ataxy, 117 

Longevity, 86 

Loss of Limbs, 56, 70, 93 

Lungs, Disease of, 128 

Mania-a-Potu, 113 

Manufacturer of the New Sphygmograph, .... 28 

Marey, Professor, 17 54 

Medicines. See " Action of," 



168 INDEX. 

PAGE 

Metrorrhagia, 46, 70, 124 

Minor Disturbances of the Pulse, 93 



Nervous Element in a Tracing, 113 

Nervous System, Affections of, . . . . . .113 

Oscillation, 64, 65, 72 

Over-work, 91 

Over-exertion, 93 

Ovaritis, 94, 123 

Pen Described, 25 

Pericarditis. See " Disease of the Heart." 

Phthisis, 47, 57, 58, 126, 128 

Pressure, Element of, 26, 64 

Prognosis, 86 

Progresso-loco moto-ataxia, 117 

Pulmonary Diseases, 128 

Pulse, Characteristic Tracings of, 86 

Pulse, Indications afforded by, 30 

Quinine, Action of, 158 

Recoil, Wave of, . 64, 75 

Regurgitation. See " Disease of the Heart." 

Rheumatism, 126, 127 

Rhythm, 35 

Sanderson, Professor, 21, 35 

Second Event, Significance of, 50 

Senile Gangrene, 125 



INDEX. 169 

PAGE 

Singular Cases, 121 

Stomach, Empty or Full, 93 

Sunstroke, 114 

Tension of Arteries and Veins, ....... 35 

Third Event, 51, 53 

Tobacco, Influence of, 57, 71, 95, 96, 100 

Translation of Tracings, 38 

Value of Means of Registering Pressure, ..... 80 
Valvular Disease. See " Disease of the Heart." 

Variations Compatible with Health, 91 

Vertigo, 55, 103, 110, 113 

Vibration, 65 

Vierordt, 17 

Volume of Pulse, ......... 34 

Waves, Successive, explained, 39 

Whittingham, Dr., of New Jersey, Singular Case by, . . 69 



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the subject. — Pacific Medical and Surgical Journal. 

It is with great gratification that we are enabled to class Dr. Meadows' Manual as a rare 
exception, and to pronounce it an accurate, practical, and creditable work, and to unhesi- 
tatingly recommend it to both student and practitioner. — American Journal of Obstetrics. 

It is a book of decided merit : every page teems with sound, practical common sense, advice 
and suggestions. — Kansas City Medical Journal. 



SOELBERG WELLS ON THE EYE. 

THE AUTHOR'S THIRD REVISED AND ENLARGED 

EDITION, PRINTED IN LONDON UNDER HIS 

IMMEDIATE SUPERINTENDENCE. 

AND PUBLISHED IN THIS COUNTRY BY SPECIAL 
ARRANGEMENT WITH HIM. 

A TREATISE ON THE DISEASES OF THE EYE, illustrated 
by Ophthalmoscopic Plates done in Chromo-Lithography, and nu- 
merous Engravings on wood. By J. Soelberg Wells, Professor of 
Ophthalmology in King's College, London ; Ophthalmic Surgeon to 
King's College Hospital, and Assistant Surgeon to the Royal London 
Ophthalmic Hospital, &c, &c. 
The Author's long experience in the treatment of Diseases of the Eye, together with the 
unusual facilities possessed by him, as Professor of Ophthalmology, and as Surgeon to King's 
College, and the Royal London Ophthalmic Hospital, has enabled him to make a most com- 
plete and comprehensive work. It embodies all the most recent views in Ophthalmology, as 
well as the newest operations upon the eye, fully illustrated. The Ophthalmoscope and 
ITS Use in the internal diseases of the eye receives, also, the fullest consideration, and is 
illustrated by beautifully colored plates. 

The rapid sale of the first and second editions, and its translation into the French and 
German languages, has given the work a world-wide reputation as the best on the subject 
in the English language. 

Royal Octavo, Price, bound in cloth $S-°° 

" " " " leather . . . . .6.00 

" Of all works in the English language on the subject, it is the best adapted to the wants 
of the general practitioner. It is thoroughly up to date, well illustrated, readable, and 
handy." — Edinburgh Medical Journal. 

" We welcome the speedy appearance of a new edition of this comprehensive volume, and 
congratulate the profession upon the opportunity it affords them of obtaining an encyclopedic 
knowledge of eye disease in a single volume." — London Lancet. 

" Of the work we may assuredly say that for English students and practitioners it is cer- 
tainly the standard book on the subject. It is very complete, and the descriptions are clearly 
and interestingly written." — British Medical Journal. 

" The book contains an admirable, and, on the whole, succinct account of diseases of the 
eye. The additions have been most judiciously made. In every respect it is most reliable 
authority." — Medical Timts and Gazette. 

" It must now fill the place formerly oocupied by the classic works of Lawrence and 
.Mackenzie." — American Journal of Medical Sciences. 

BY SAME AUTHOR. 

ON LONG, SHORT, AND WEAK SIGHT, and their Treatment 
by the Scientific Use of Spectacles. Third Edition, Revised, with 
Additions and Numerous Illustrations. Octavo. Price . . $3.00 



A COMPLETE TEXT-BOOK 

ON DISEASES AND INJURIES OP THE EYE. 

LINDSAY & BLAKISTON HAVE NOW READY, 

The Diseases and Injuries of the Eye, their 
Medical and Surgical Treatment, wm illustrations. 

By George Lawson, F.R.C.S., Surgeon to the Royal London Ophthalmic 
Hospital, and Assistant Surgeon to the Middlesex Hospital. In one volume, 
royal 12mo. Price, $2.50 

This Manual comprises a brief account of all the Medical and Surgical 
Affections of the Eye, with the Treatment essential for their relief, each 
subject being discussed in a separate section under its own peculiar head- 
ing. The very favorable notices appended below attest its great value to 
the student. 

" We have been fully supplied in the last two or three years with systematic treatises 
on diseases of the eye. But there seems still to be room for a clear, brief, and concise 
yet practically full manual on modern ophthalmic medicine and surgery, such as 
might serve for a text-book for students and a companion for the busy practitioner. 
This Mr. Lawson has supplied, and supplied admirably well. Of his qualifications 
for the task of producing such a work it would be superfluous to speak. He ia a 
' Past Master ' on the subject, and while any work of his is sure of a favorable reception, 
he has taught the profession to judge him by a high standard of excellency, and so 
judged the book we now notice will certainly not disappoint its readers. Necessarily 
brief and concise as to details, it is admirably clear and eminently practical. The 
reader feels that he is in the hands of a teacher who has a right to speak with author- 
ity, and who, if he may be said to be positive, is so from the fulness of knowledge 
and experience, and who, while well acquainted with the writings and labors of other 
authorities on the matters he treats of, has himself practically worked out what he 
teaches." — London Medical Times and Gazette, Aug. 14, 1869. 

"We congratulate Mr. Lawson on the production of such an excellent work on 
ophthalmic diseases as this. Without depreciating the large and valuable treatises on 
this subject that have recently appeared, we have long felt that a manual was wanted 
which would serve as a text-book for students, and also should form a trustworthy guide 
for practitioners in dealing with diseases of the eye. Well has Mr. Lawson supplied 
this want. He has described the various affections of the eye, briefly but yet cleai-ly, 
and from the large experience he has acquired as surgeon to the Royal London Oph- 
thalmic Hospital, Moorfields, he has made his work thoroughly practical. The profession 
will find this manual just the sort of work they want on eye diseases, vhile to the 
student it will be invaluable as a text-book." — British Medical Journal, July 24, 1869 

" This handy and beautifully printed volume is as good in the quality of its 
contents as it is attractive to the eye. Mr. Lawson has long been known as an oph- 
thalmic surgeon, he has enjoyed a long experience, and he has the faculty of telling 
his story clearly. He has here given us a manual of moderate size, in which the 
practitioner will find short and clear descriptions and directions for the treatment of 
every kind of eye disease. The work is sure to become very popular, and to enjoy a 
large circulation." — Practitioner, Aug., 1869. 



Hewitt's Diagnosis, Pathology, and Treatment of 
the Diseases of Women. 

THE THIRD EDITION NOW READY. 

Revised, Enlarged, Rearranged, and Mostly Rewritten; with 
Many New Illustrations. 

Price in Cloth $5.00. In Leather $6.00. 
OPINIONS OF THE PKESS ON THE THIRD EDITION. 

The changes and additions which have been made, as well as the general rearrange- 
ment of the whole subject matter, render this new edition an essentially new work. — 
Chicago Med. Examiner. 

It forms a volume of 740 pages, numerously illustrated, and though called a new edition, 
it is really a new work. The style is attractive and practical, the mechanical execution 
of the work creditable, and as a reliable guide in the treatment of diseases peculiar to 
women it has no superior. — Canada Lancet. 

It now forms a complete and systematic treatise, admirable in arrangement, beautiful 
in appearance, and rich in the wisdom that comes from ample experience, mature thought 
and active industry. — Leavenworth Herald. 

He has really rewritten the former edition, embodying his extensive clinical experi- 
ence, making this edition a most complete and thorough work on all that pertains to the 
pathology and treatment of diseases peculiar to women. — Cincinnati Medical News. 

For those who desire full instruction and careful illustration in this department nothing 
can equal the work before us; the philosophy of mechanics, and the modes of applica- 
tion are fully presented. — Buffalo Medical and Surgical Journal. 

It is unquestionably one of the most valuable guides to a correct diagnosis to be found 
in the English language. — Richmond and Louisville Journal. 

The latest, best, and most authoritative exponent of a well-defined bias that powerfully 
affects a zealous class of gynecologists . . . We hail Dr. Graily Hewitt's work as the 
lineal successor to Simpson's. — Brit. Med. Jour. 

The style is clear and very readable, and it gives evidence throughout of honest hard 
work ; not that of the office book-worm, but of the careful clinical observer. — Canada 
Med. and Surg. Jour. 

RECENTLY PUBLISHED. 

Dillnberger's Handy-Book of the Treatment of 
Women and Children's Diseases, according to the Vienna 

Medical School. 
Part I. The Diseases of Women. Part. II. The Diseases of Children. 

Translated from the Second German Edition, by P. Nicol, M. D. One 
volume i2mo. Price . . . . . . . . $1.75 

We noticed favorably the original of this hand-book some months ago, and suggested that 
an English translation of it, with notes showing the main points wherein the practice of our 
medical schools differs from that at Vienna, might be well received. Mr. Nicol has now 
carried out this idea, and we imagine that many practitioners will be glad to possess this little 
manual, which gives a large mass of practical hints respecting the treatment of diseases 
which probably make up the larger half of every-day practice. The translation is well 
and correctly performed, and the necessary explanations of reference to German medicinal 
preparations are given with proper fulness. — The Practitioner. 



New Book on Diseases of Women. 

SECOND EDITION, REVISED AND ENLARGED. 

Atthill's Clinical Lectures on Diseases Pecul- 
iar tO Women. By Lombe Atthill, M.D., Fellow and 
Examiner in Midwifery, King and Queen's College of Physicians; 
Obstetric Physician to the Adelaide Hospital, and formerly Assistant 
Physician to the Rotundo Lying-in Hospital. Demy Octavo, with 
Illustrations. Now Ready. Price, $2.25 

" This excellent little book has three great merits. It treats of very common diseases 
which are generally very badly taught in our Schools. Secondly, it treats of them in 
a thoroughly clinical and practical way ; and finally, without being too short, is a 
compact book, calculated to be very useful to the practitioner. Dr. Atthill's practice, 
if not original, is thoroughly independent, and he illustrates it with a copious quota- 
tion of good cases. We commend the whole book to the careful attention of advanced 
students and general practitioners." — Lancet, March 23, 1872. 

" The lectures before us have the merit of calling attention to this important subject 
with the voice of personal experience. Those on Menorrhagia, endo-Metritis, and 
endo-Cervicitis, we would specially point out as worthy of note; and, without endors- 
ing the author's therapeutic treatment of those atfections, we cannot but admire the 
clearness of style and practical character of their literary treatment." — Glasgow 
Medical Journal, May, 1872. 

'• These lectures form an admirable text-book for students. Dr. Atthill, as Examiner 
in the Queen's University and College of Physicians of Ireland, discovered the utter 
ignorance of the majority of students on the important subject of Diseases Peculiar to 
Women. The publication of this little volume supplies a want that has long been felt 
by students preparing for examination. In these lectures is to be found a clear and 
concise summary of the clinical practice of the diseases peculiar to women. The work 
is the result of large and accurate clinical observation, recorded in an admirably terse and 
perspicuous style, and is remarkable for the best qualities of a practical guide to the 
student and practitioner." — British Medical Journal, May 11, 1872. 

"A most excellent though brief hand-book on the Diseases Peculiar to Women ; one 
that cannot fail to be of great use to students, and that will guide them to a right 
understanding of the cases brought before them in their hospital practice. Nor is 
this all; to the busy practitioner this book will be of use in many an emergency, not 
only assisting him in the recognition of the various forms of disease most frequently 
met with, but also forming a safe and reliable guide to their treatment on sound and 
scientific principles. We think Dr. Atthill has done good service in publishing his 
lectures, and we strongly recommend them to the careful and attentive perusal of all 
who wish to study the diseases of women." — Dublin Journal of Medical Science, Novem- 
ber, 1871. 

Acton on the Functions and Disorders of the 
Reproductive Organs. 

In Childhood, Youth, Adult Age, and Advanced Life, considered in their 
Physiological, Social, and Moral Relations. By William Acton, 
M. R. C S., etc. Third American, from the Fifth London Edition. 
Carefully revised by the author, with additions. Just ready. Octavo. 
Price $3.00 

To such of our readers as are not familiar with Acton's book, we may say that his plan em- 
braces the consideration of topics of great interest : such as are peculiar to childhood, embracing 
its vices ; those peculiar to precocity and included in masturbation ; similar inquiries pertaining 
to youth and adult age, and so on through the stages of life with its inquiries. Indeed, we 
may say that all those delicate matters pertaining to the male sexual conditions are treated in 
this volume with singular care and intelligence — Lancet and Observer, October, 1871. 



Byford on the Uterus, second edition. 

On the Chronic Inflammation and Displacement of the Unimpregnatea 
Uterus. A New, Enlarged, and Thoroughly Revised Edition, with 
Numerous Illustrations. Now Ready. One volume. Octavo. $3.00 

From Fordyce Barker, M.D., Professor of Obstetrics and Diseases of Women and Children 
in Bellevue Hospital Medical College. 
Some weeks ago I received a copy of your work on the Uterus. I have delayed 
acknowledging the favor until I could give the book a careful perusal. I have just • 
finished a thorough reading of it. I feel personally indebted to you, not merely for the 
copy — which, of course, I should have bought — but for writing the book ; and I think 
you have laid the Profession in this country under a load of obligation by giving them 
such a clear, concise, and practical treatise on a class of affections *hat even now ia 
very little understood by the greater majority. 

From R. A. F. Penrose, M.D., Professor of Obstetrics in the University of Pennsylvania. 

Accept my thanks for the copy of your new work which you so kindly sent me. I 
have, as yet, not had time to give it the careful study it merits ; hut from the super- 
ficial inspection I have made, I find much that is most valuable. t 

From S. G. Hubbard, M.D., Professor of Obstetrics in Tale College, New Haven. 

I was gratified by the receipt of your new work on the Uterus, and I thank you sin- 
cerely for it. I have spent all my leisure in its examination, and have derived both 
pleasure and profit from its perusal. It is commendable for its clearness and definite- 
ness as well as for the great practical common sense which pervades it. I am sure that 
it will prove a very useful treatise, not only to junior practitioners, but to those also 
among us who, from not having devoted themselves to the treatment of uterine disease, 
as a specialty, have neither time nor opportunity to make original investigations in this 
department, and are not, therefore, perfectly at home in its practice. 

From James P. White, Professor of Obstetrics and Diseases of Women and Children in the 
University of Buffalo. 
I have had time, as yet, to run over but few of the chapters of your work on the 
Cterus; I am most happy, however, in being able to say that, so far as I have read, it 
does credit to American authorship. It is concise and brief, and eminently practical. 
The work was certainly a desideratum, and will be especially useful to practitioners 
who can illy afford to purchase all or most of the works referred to in your preface. I 
shall examine it with much interest, and, no doubt, often consult it with profit. 

From G. S. Bedford, M.D., Professor of Obstetrics and Diseases of Women aud Children 
in the University of Neiv York. 
On my return to the city I found on my table il Byford on the Uterus." The next day 
I commenced perusing it, and have read it from cover to cover. I need not say that, 
in my judgment, the book enhances your deserved reputation. You have, if my opin- 
ion be worth anything, given the Profession an excellent work, and one that is sensible 
and practical. Go on, my dear Doctor, and give us more of your experience. It ia 
what the Profession most needs — the experience of good and ripe minds. 

RECENTLY PUBLISHED, THE SECOND EDITION OP 

Byford's Practice of Medicine and Surgery. 

Applied to the Diseases and Accidents Incident to Women. By W. H. 
Byford, A.M., M.D., Professor of Obstetrics and Diseases of Women 
and Children in the Chicago Medical College, &c, &c. The Second 
Edition, Revised and Enlarged, with Additional Illustrations. One 

volume. Octavo $5.00 

The rapid sale of the first edition of this book, which was exhausted in a little more 
than a year, has enabled the author to carefully revise the whole work, add many im- 
provements, and to make a large addition of new matter, without, however, materially 
increasing the size of the volume. 

This work treats well-nigh all the diseases incident to women, diseases and accidents 
of the vulva and perineum, stone in the bladder, inflammation of the vagina, menstrua- 
tion and its disorders, the uterus and its ailments, ovarian tumors, diseases of the mam- 
mas, puerperal convulsions, phlegmasia alba dolens, puerperal fever, &c. Its scope is 
thus of the most extended character, yet the observations are concise but convey much 
practical information. — London Lancet. 



MEIGS AND PEPPER ON CHILDREN. 

"The most thorough and Practical Work on the subject now before the 
Profession." 

THE PIFTH EEVISED AND IMPROVED EDITION NOW EEADY. 

A PRACTICAL TREATISE on the DISEASES of CHILDREN. 
By J. Forsyth Meigs, M. D., one of the Physicians to the Pennsylvania 
Hospital, Consulting Physician to the Children's Hospital, &c, and 
William Pepper, M. D. , Physician to the Philadelphia Hospital, Fellow 
of the College of Physicians, &c, &c. The Fifth Revised and Impro\ed 
Edition. In one volume of over 960 royal octavo pages. 

The fourth edition of this work was almost entirely rearranged. Several of the articles, as 
those on Eclampsia,. Chorea, and Parasitic Skin Diseases, were much enlarged ; others, on the 
Diseases of the Stomach and Intestines, and that on Eczematous Affections, entirely rewritten. 
In addition, articles were added upon the following important subjects : 

Diseases of the Heart. Facial Paralysis. 

Cyanosis. Rheumatism. 

Diseases of the Caecum and Appendix. Diphtheria. 

Intussusception. Mumps. 

Chronic Hydrocei^halus. Rickets. 

Tetanus Nascentium. Tuberculosis. 

Atrophic Infantile Paralysis. Infantile Syphilis. 

Progressive Paralysis, with apparent Hy- Typhoid Fever, 

pertrophy of the Muscles. Sclerema. 

The rapid sale of this edition has again made it necessary for the authors to thoroughly 
revise the work, and make such additions that it will continue to represent fully, in its most 
advanced state, the present condition of medicine as applied to Children's Diseases, and 
retain that eminently practical character which the authors' long experience in this specialty 
has given to it. 

Price, handsomely bound in cloth, . . . . . $6.00 

" " " leather, .... 7.00 

The London Lancet, speaking of it, says : 

It is not necessary to say much, in the way of criticism, of a work so well known as " Meigs 
on Diseases of Children," especially when it has reached a fourth edition. It contains more 
than 900 good American pages, and is more encyclopa?dial than clinical. But it is clinical, 
and withal most effectually brought up to the light, pathological and therapeutical, of the 
present day. Like so many other good American medical books, it marvellously combines a 
resume of all the best European literature and practice, with evidence throughout of good 
personal judgment, knowledge, and experience. The book also abounds in exposition of 
American experience and observation in all that relates to the diseases of children. We are 
glad to add this work to our library. There are few diseases of children which it does not 
treat of fully and wisely in the light of the latest physiological, pathological, and therapeu- 
tical science. 



RECENTLY PUBLISHED. 

TANNER'S PRACTICAL TREATISE ON THE DISEASES 
OF INFANCY AND CHILDHOOD. Third American Edition, Re- 
vised and Enlarged. Price $3-5° 

HILLIER'S CLINICAL TREATISE ON THE DISEASES OF 
CHILDREN. Price $3.00 



"The leading feature of this book is its essentially practical character?"— 

London Lancet. 

Tanner's Practice of Medicine. 

FIFTH AMERICAN. FROM THE SIXTH LONDON EDITION 



ENLARGED AND THOROUGHLY REVISED. 

JUST READY. 

THE PRACTICE OF MEDICINE, by Thomas Hawkes Tanner, 
M.D., Fellow of the Royal College of Physicians, Author of Tanner'* 
practical Treatise on the Diseases of Children, &c, &c. Fifth Ame- 
rican Edition, with a very large Collection of Formulae. One Volume, 
Royal Octavo, containing over 1100 pages. 

Price, handsomely bound in Cloth, . . $6 00 
" " " Leather, . 1 00 



OOE"TENTS. 



»art 1. General Diseases. 

2. Fevers. 

3. Venereal Diseases. 

4. Diseases of the Nervous System. 

5. Diseases of the Organs of Respi- 
ration and Circulation. 

6. Diseases of the Thoracic Walls. 

7. Diseases of the Alimentary Canal. 

8. Diseases of the Liver. 

9. Diseases of the Pancreas and 
Spleen. 



Part 10. Diseases of the Abdominal Walls. 
" 11. Diseases of the Urinary Organs. 
" 12. Diseases of the Uterine Organs. 
" 13. Diseases of the Skin. 
" 14. Diseases of Cutaneous Append- 
ages. 
" 15. Diseases of the Bloodvessels. 
" 16. Diseases of the Absorbent System. 

Appendix of Formulae 

General Index. 



"The rapidity with which edition after edition of this work has appeared and dis- 
appeared is, on the whole, a true test of its merits. The fifth edition was, we believe, 
a very large one, yet the book was for some time out of print before the present one 
could be prepared. Dr. Tanner has chosen his title well; his work is essentially one 
on the practice of medicine in its widest sense, and it is in what relates to pure prac- 
tice, as contradistinguished fram the theory of medicine, that the book is strongest; 
for it has been the author's aim to collect everything he could think of which would 
aid the practitioner in the discharge of his duties. But it is not to men engaged in 
the active discharge of the duties of their profession alone to whom the book is wel- 
come. With the student, preparing himself to enter upon these duties, the book has 
long been a favorite, chiefly, we believe, from the lucidity of its style and the character 
of its substance. Other books there are, more eloquent and more recondite, but none 
excel Dr. Tanner's work in these important features. All that is necessary to know 
is here, disposed in such a manner as to admit of the readiest reference, and of being 
most easily retained in the memory. Our limits will not admit of an extended review, 
which would be out of place with regard to a book practically established as a standard. 
It carries its own recommendation, and is its own best passport to general use. It has 
been the result of very great labor — labor well spent; and it appears in a form which 
la creditable to its publishers as it is pleasing to those who have to use the hook. — 
British and Foreign Medico- Chirurgical Review, April, 1870. 

" Dr. Tanner's works are all essentially and thoroughly practical, — he never for on« 
moment allows this utilitarian end to escape his mental view. He aims at teaching how 
to recognize and how to cure disease, and in this he is thoroughly successful. It in 
indeed a wonderful mine of knowledge." — Medical Times and Gazette, July, 1869. 



SANDERSON AND FOSTER'S PHYSIOLOGICAL 
HAND-BOOK. Elegantly Illustrated. 

A HAND-BOOK FOR THE PHYSIOLOGICAL LABORATORY, 

Being Practical Exercises for Students in Physiology and Histology, by 
E. Klein, M. D., Assistant Professor in the Pathological Laboratory 
of the Brown Institution, London; J. Burdon-Sanderson, M.D., 
F.R.S., Professor of Practical Physiology in University College, Lon- 
don ; Michael Foster, M.D., F.R.S., Fellow of and Prselector of Phy- 
siology in Trinity College, Cambridge; and T. Lauder Brunton, M.D., 
D.Sc, Lecturer on Materia Medica in the Medical College of St. Bar- 
tholomew's Hospital. Edited by J. Burdon-Sanderson. 

This book is intended for beginners in physiological work. It is a book of methods, not a 
compendium of the science of physiology, and consequently claims a place rather in the 
laboratory than in the study. But although designed for workers, it will be found not the 
less useful to those who desire to inform themselves by reading as to the extent to which the 
science is based on experiment, and as to the nature of the experiments which chiefly deserve 
to be regarded as fundamental. 

The illustrations to the book, which consist of One Hundred and Twenty-Three Oc- 
tavo pages, and include over Three Hundred and Fifty Figures, each having appro- 
priate letter-press explanations attached with references to the Text, when necessary, are 
bound in a separate volume for more convenient reference. 

Price of the two volumes ....... $8.00 

" The publication of this work marks an era in the history of Physiology in this country 
and throughout the world, for there is indeed no other such work in any language. It 
teaches the study of nature as nearly as possible under natural conditions. 

" The four authors have each selected a definite division. Dr. Klein is solely responsible 
for the Histological portion. This is characterized by a fulness of practical knowledge which is 
very rare, and can only be attained by many years of study and inquiry. Dr. Sanderson 
for that relating to Heat, Circulation, and Respiration. This is most excellent ; he deals 
with a difficult subject, and has done so in a masterly way. Dr. Foster's subject is 
the Muscles and Nerves, a subject not less interesting, but having, in many respects, a less 
practical bearing. Dr. Brunton's is Digestion and Secretion, which is exceedingly good 
and thoroughly practical. It is, upon the whole, a book of very great value. Its aim is essen- 
tially practical. As a laboratory guide it has no equal." — London Medical Times and Gazette. 

" The profession must feel deeply indebted to Dr. Sanderson and his coadjutors for the 
ability with which this whole work is prepared, for the clearness of the descriptions, their 
excellent arrangement, and judicious selection. The book is perfectly unique, and will prove 
of equal value to both student and teacher." — London Lancet. 

" No more useful aids to medical instruction have been supplied us in modern times than 
these volumes furnish. They are the first fruits of the new education, the object of which is 
to teach men to observe, think, and deduce, as well as to remember. We are told that the 
book is intended for beginners in physiological work, but we believe there are no teachers of 
physiology and histology in this country who would not teach with new enthusiasm by 
making it their guide. We believe, moreover, that there is no other book, in any language, 
so useful to teacher or student in the departments which it covers. For, in addition to the 
fact that there is no single work in the German which covers so extended a field, there is, 
even in those extant, a want of preciseness in the directions given which makes them un- 
satisfactory to beginners." — Philadelphia Medical Times. 

" We feel that we cannot recommend this work too highly. To those who are engaged in 
physiological work as students or teachers, it will be almost indispensable ; and to those who 
are not, a perusal of it will by no means be. unprofitable. The execution of the plates leaves 
nothing to be desired. They are mostly original ; their arrangement in a separate volume has 
great and obvious advantages." — Dublin Journal of Medical Sciences. 

" The authors of these volumes are masters of the subjects upon which they wrote. They 
have devoted themselves to the laborious investigation of each physiological detail involving 
manipulations, vivisections, chemical analysis, researches by the aid of the microscope, &c, 
&c, and they have presented us with a collection of the most erudite and valuable practical 
treatises upon their respective subjects which can be found in the English language. It is 
filled with practical detail and minute instruction." — Charleston Medical Journal and Review. 



TROUSSEAU'S CLINICAL MEDICINE. 

COMPLETE. 
In Two Large Royal Octavo Volumes, 

EMBBACING ALL THE LECTUKES CONTAINED IN THE FIVE 

VOLUME EDITION AS ISSUED BY THE 

SYDENHAM SOCIETY. 

Price, handsomely bound in cloth $10.00 

leather 12.00 

Lectures on Clinical Medicine. 

Delivered at the Hotel Dieu, Paris, by A. Trousseau, Professor of Clin- 
ical Medicine to the Faculty of Medicine, Paris, &c, &c. Translated 
from the Third Revised and Enlarged Edition by P. Victor Bazire, 
M. D., London and Paris; and John Rose Cormack, M.D., Edinburgh, 
F. R. S., &c. With a full Index, Table of Contents, &c. 

Trousseau's Lectures have attained a reputation both in England and in this country far 
greater than any work of a similar character heretofore written, and, notwithstanding but few 
medical men could afford to purchase the expensive edition issued by the Sydenham Soci- 
ety, it has had an extensive sale. In order, however, to bring the work within the reach of all 
the profession, the publishers now issue this edition, containing all the lectures as contained 
in the five volume edition, at one-half the price. The London Lancet, in speaking of the 
work, says : 

" It treats of diseases of daily occurrence and of the most vital interest to the practitioner. 
And we should think any medical library absurdly incomplete now which did not have 
alongside of Watson, Graves, and Tanner, the ' Clinical Medicine ' of Trousseau." 

Some opinion of the great value of the work can be formed from the titles of the Lectures 
as given below. A very full Table of Contents is furnished in each volume. 

CONTENTS OF VOLUME ONE. 
Lecture 1. Small-pox. 2. Variolous Inoculation. 3. Cow-pox. 4. Chicken-pox. 5. 
Scarlatina. 6. Measles, and in particular its unfavorable Symptoms and Complications. 7. 
Rubeola. 8. Erythema Nodosum. 9. Erythema Papulatum. 10. Erysipelas, and in par- 
ticular Erysipelas of the Face. 11. Mumps. 12. Urticaria. 13. Zona, or Herpes Zoster. 
14. Sudoi - al Exanthemata. 15. Dothinenteria, or Typhoid Fever. 16. Typhus. 17. Mem- 
branous Sore Throat, and in particular Herpes of the Pharynx. 18. Gangrenous Sore 
Throat. 19. Inflammatory Sore Throat. 20. Diphtheria. 21. Thrush. 22. Specific Ele- 
ment in Disease. 23. Contagion. 24. Ozsena. 25. Stridulous Laryngitis, or False Croup. 
26. GMerna of the Larynx. 27. Aphonia: Cauterization of the Larynx. 28. Dilatation of 
the Bronchi, and Bronchorrhcea. 29. Hsemoptysis. 30. Pulmonary Phthisis. 31. Gangrene 
of the Lung. 32. Pleurisy : Paracentesis of the Chest. 33. Traumatic Effusion of Blood into 
the Pleura : Paracentesis of the Chest. 34. Hydatids of the Lung. 35. Pulmonary Abscesses 
and Peripneumonic Vomicae. 36. Treatment of Pneumonia. 37. Paracentesis of the Peri- 
cardium. 38. Organic Affections of the Heart. 39. On Venesection in Cerebral Hemor- 
rhage and Apoplexy. 40. On Apoplectiform Cerebral Congestion, and its Relations to Epi- 
lepsy and Eclampsia. 41. On Epilepsy. 42. On Epileptiform Neuralgia. 43. Infantile 
Convulsions. 44. Eclampsia of Pregnant and Parturient Women. 45. On Tetany. 46. On 
Chorea. 47. Senile Trembling and Paralysis Agitans. 48. Cerebral Fever. 49. Cross- 
paralysis, or Alternate Hemiplegia. 50. Facial Paralysis, or Bell's Paralysis. 51. On 
Glosso-laryngeal Paralysis. 



CONTENTS OF VOLUME TWO. 

Lecture 52. Alcoholism. 53. On Neuralgia. 54. Hydrophobia. 55. Asthma. 56 
Hooping-Cough. 57. Angina Pectoris. 58. Exophthalmic Goitre, or Graves' Disease. 59. 
Progressive Locomotor Ataxy. 60. Progressive Muscular Atrophy. 61. On Aphasia. 62. 
Spermatorrhoea. 63. Nocturnal Incontinence of Urine. 64. Glucosuria: Saccharine Dia- 
betes. 65. Polydipsia. 66. Cerebral Rheumatism. 67. Vertigo a Stomacho Lseso. 68. Dys- 
pepsia. 69. Chronic Gastritis. 70. Simple Chronic Ulcer of the Stomach. 71. Diarrhoea 
— Chronic Diarrhoea. 72. Infantile Cholera — Diarrhoea of Children. 73. Lactation, First 
Dentition, and the Weaning of Infants. 74. Dysentery. 75. Constipation. 76. Fissure of 
the Anus. 77. Intestinal Occlusions. 78. Hepatic Colic : Biliary Calculus. 79. Hydatid 
Cysts of the Liver. 80. Malignant Jaundice. 81. Syphilis in Infants. 82. Gout. 83. Nodu- 
lar Rheumatism, erroneously called Rheumatic Gout. 84. Acute Articular Rheumatism 
and Ulcerating Endocarditis. 85. Marsh Fevers : Intermittent Fevers. 86. Rickets. 87. 
True and False Chlorosis. 88. Cirrhosis. 89. Addison's Disease. 90. Leucocythaemia. 
91. Adenia. 92. Amenorrhoea and Menorrhagic Fever. 93. Pelvic Hsematocele. 94. Puer- 
peral Purulent Infection. 95. Phlegmasia Alba Dolens. 96. Perinephric Abscess. 97. 
Perihysteric Abscess. 98. New Species of Anasarca the Sequel of Retention of Urine. 
99. Movable Kidney. 100. Loosening of the Pelvic Symphyses. 101. Percussion. Index. 

" The Clinical Lectures of Prof. Trousseau, in attractiveness of manner and richness of 
thoroughly practical matter, worthily takes its place beside the classical lectures of Watson 
and Graves. Very rarely it occurs that a book on medicine is met with so pleasant to read, 
and so abundant in sound practical instruction. In reading Trousseau's book we feel as 
though the learned, eloquent, accomplished teacher; the observant, suggestive, and accom- 
plished physician, were speaking, viva voce. The remarkably graphic narrative of the cases 
present true and impressive pictures of disease, and retain for the book that interest which is 
generally limited to the living voice of the clinical teacher. The reader sees Trousseau's 
patients with him, listens to his remarks on their diseases, and applies to them individually 
the precepts inculcated and the pathological opinions set forth." — British Medical Journal. 

" The work is full of the results of the richest natural observation, and is the production 
of one who was enlightened enough to combine with new methods of investigation the vigor- 
ous and independent ideas of the old physicians whom he so eloquently magnifies. It is an 
extremely rich and valuable addition to the library of physicians and practitioners generally." 

— London Lancet. 

" This book furnishes an example of the best kind of clinical teaching. It deserves to be 
popularized. We scarcely know of any work better fitted for presentation to a young man 
when entering upon the practical work of his life. The delineation of the recorded cases is 
graphic, and their narration devoid of that prolixity which, desirable as it is for purposes of 
extended analysis, is highly undesirable when the object is to point to a practical lesson." — 
London Medical Times and Gazette. 

"The publication of Trousseau's Lectures furnishes medical men with one of the best 
practical treatises on disease as seen at the bedside. The conversational style adopted by 
the author lends animation to the work, and the translator deserves credit for having so well 
preserved the easy and ready style of the original." — British and Foreign Medico- Chirur- 
gical Review. 

" The great reputation of Prof. Trousseau as a practitioner and teacher of Medicine in all 
its branches, renders the present appearance of his Clinical Lectures particularly welcome." 

— Medical Press and Circular. 

" A clever translation of Prof. Trousseau's admirable and exhaustive work, the best book 
of reference upon the Practice of Medicine." — Jndian Medical Gazette. 

The Sydenham Society's Edition of Trousseau can still be furnished 

in sets, or in separate volumes, as follows : 

Volumes I., II., and III., $5.00 each. Volumes IV. and V., $4.00 each. 



NEW BOOKS, JUST READY. 



PROF. AGNEW ON THE LACERATIONS OF THE FEMALE 
PERINEUM, AND VESICO-VAGINAL FISTULA, their History and 
Treatment, with numerous illustrations engraved on wood. By D. 
Hayes Agnew, M.D., Professor of Surgery in the University of Penn- 
sylvania, &c., &c. In one volume octavo. Price . . $2.00 

PARKES' MANUAL OF PRACTICAL HYGIENE, the fourth 
revised and enlarged edition, for Medical Officers of the Army, 
Civil Medical Officers, Boards of Health, &c, &c. By Edward A. 
Parkes, M.D., Professor of Military Hygiene in the Army Medical 
School, &c, &c. With many Illustrations. One volume octavo. 
Price $6.00 

" This work, previously unrivalled as a text-book for medical officers of the army, is now 
equally unrivalled as a text-book for civil medical officers. The first book treats in succes- 
sive chapters of water, air, ventilation, examination of air, food, quality, choice, and cooking 
of food, beverages, and condiments; soil, habitations, removal of excreta, warming of houses, 
exercise, clothing, climate, meteorology, individual hygienic management, disposal of the 
dead, the prevention of some common diseases, disinfection, and statistics. The second 
book is devoted to the service of the soldier, but is hardly less instructive to the civil officer 
of health. It is, in short, a comprehensive and trustworthy text-book of hygiene for the 
scientific or general reader." — London Lancet, July, 1873. 

SIR HENRY THOMPSON ON THE PREVENTITIVE TREAT- 
MENT OF CALCULOUS DISEASE, and the Use of Solvent Reme- 
dies. By Sir Henry Thompson, F.R.C.S., &c. 161110. Price $1.00 

COLES' MANUAL OF DENTAL MECHANICS, with an account 
of the Material and Appliances used in Mechanical Dentistry. By A. 
Oakley Coles, D.D.S. With 140 Illustrations. Price . . $2.50 

This work has been prepared mainly as a Text-Book for the student, but its practical 
character must certainly make it useful to every practitioner of Dentistry. 

CLARKE'S TREATISE ON DISEASES OF THE TONGUE. 

By W. Farlie Clarke, M.D., Assistant Surgeon to Charing Cross 
Hospital, &c. With Lithographic and Woodcut Illustrations. Octavo. 
Price . . . . . . . . . . $5-°° 

It contains The Anatomy and Physiology of the Tongue, Importance of its Minute Exam- 
ination, Its Congenital Defects, Atrophy, Hypertrophy, Parasitic Diseases, Inflammation, 
Syphilis and its effects, Various Tumors to which it is subject, Accidents, Injuries, &c, &c. 

BUCKNILL AND TUKE'S MANUAL OF PSYCHOLOGICAL 
MEDICINE, containing the History, Nosology, Description, Statistics, 
Diagnosis, Pathology, and Treatment of Insanity, with an Appendix of 
Cases. By J. C. Bucknill, M.D., F.R.S., and Daniel H. Tuke, M.D. 
The Third Edition, Revised and Enlarged. One volume octavo. 

COOPER'S DICTIONARY OF PRACTICAL SURGERY, and 

Encyclopedia of Surgical Science. A New Enlarged and Revised Lon- 
don Edition, in 2 vols, of over 1000 pages each. Price . $15.00 



Recent Publications 

BY 

LINDSAY & BLAKISTON. 



AITKEN (william), M. D., 

Professor of Pathology in the Army Medical School, &c. 

THE SCIENCE AND PRACTICE OF MEDICINE. THIRD 
American, from the Sixth London Edition. Thoroughly Revised, 
Remodelled, many portions Rewritten, with Additions almost equal to 
a Third Volume, and numerous additional Illustrations, without any 
increase in bulk or price. Containing a Colored Map showing the 
Geographical Distribution of Disease over the Globe, a Lithographic 
Plate, and nearly 200 Illustrations on Wood. 

Two volumes, royal octavo, bound in cloth, price, . . $12.00 

" " " " leather, . . 14.00 

For eighteen months Dr. Aitken has been engaged in again carefully revising this Great 
Work, and adding to it many valuable additions and improvements, amounting in the ag- 
gregate almost to a volume of new matter, included in which will be found the adoption and 
incorporation in the text of the " New Nomenclature of the Royal College of Physicians of 
London; " to which are added the Definitions and the Foreign Equivalents for their English 
names ; the New Classification of Disease as adopted by the Royal College of Physicians, &c. 

The American editor, Meredith Clymer, M. D., has also added to it many 
valuable articles, with special reference to the wants of the American Prac- 
titioner. 

The work is now, by almost universal consent, both in England and the United States, 
acknowledged to be in advance of all other works on The Science and Practice of Medicine. 
It is a most thorough and complete Text-book for students of medicine, following such a 
systematic arrangement as will give them a consistent view of the main facts, doctrines, and 
practice of medicine, in accordance with accurate physiological and pathological principles 
and the present state of science. For the practitioner it will be found equally acceptable as 
a work of reference. 

ALLINGHAM (william), F.R.C.S., 

Surgeon to St. Mark's Hospital for Fistula, &c, 

FISTULA, HEMORRHOIDS, PAINFUL ULCER, STRICT- 
URE, PROLAPSUS, and other Diseases of the Rectum, their Diagnosis 
and Treatment. Second Edition, Revised and Enlarged by the 
Author. Price . . . . . . . . . |2.oo 

This book has been well received by the Profession ; the first edition sold rap- 
idly ; the present one has been revised by the author, and some additions made, 
chiefly as to the mode of treatment. 

The Medical Press and Circular, speaking of it, says : " No book on this special subject 
can at all approach Mr. Allingham's in precision, clearness, and practical good sense." 

The London Lancet : " As a practical guide to the treatment of affections of the lower 
bowel, this book is worthy of all commendation." 

The Edinburgh Monthly : " We cordially recommend it as well deserving the careful study 
of Physicians and Surg 



ATTHILL (lombe), M. D., 

Fellow and Examiner in Midwifery, King and Queen's College of Physicians, Dublin, 

CLINICAL LECTURES ON DISEASES PECULIAR TO WO- 
MEN. Second Edition, Revised and Enlarged, with Six Lithographic 
Plates and other Illustrations on Wood. Price . . . $2.25 

The value and popularity of this book is proved by the rapid sale of the first edition, 
which was exhausted in less than a •year from the time of its publication. It appears to 
possess three great merits : First, It treats of the diseases very common to females. Second, 
It treats of them in a thoroughly clinical and practical manner. Third, It is concise, orig- 
inal, and illustrated by numerous cases from the author's own experience. His style is clear 
and the volume is the result of the author's large and accurate clinical observation recorded 
in a remarkable, perspicuous, and terse manner, and is conspicuous for the best qualities of 
a practical guide to the student and practitioner. — British Medical Journal. 

ALTHAUS (juuus), M. D., 

Physician to the Infirmary for Epilepsy and Paralysis. 
THIRD ENLARGED EDITION, 146 ILLUSTRATIONS. 

A TREATISE ON MEDICAL ELECTRICITY, Theoretical and 
Practical, and its Use in the Treatment of Paralysis, Neuralgia, and other 
Diseases. Third Edition, Enlarged and Revised, with One Hundred 
and Forty-six Illustrations. In one volume octavo. Price . $6.00 

ADAMS (william), F. R. C.S., 

Surgeon to the Royal Orthopedic and Great Northern Hospitals. 

CLUB-FOOT: ITS CAUSES, PATHOLOGY, AND TREAT- 
MENT. Being the Jacksonian Prize Essay of the Royal College of 
Surgeons. A New Revised and Enlarged Edition, with 106 Illustrations 
engraved on Wood, and Six Lithographic Plates. A large Octavo 
Volume. Price ......... $6.00 



ADAMS (robert), M.D., 

Regius Professor of Surgery in the University of Dublin, &.C., &c. 

RHEUMATIC GOUT, or CHRONIC RHEUMATIC ARTHRI- 
TIS OF ALL THE JOINTS. The Second Edition. Illustrated by 
numerous Woodcuts, and a quarto Atlas of Plates. 2 Volumes. 
Price . $8.50 

BASHAM (w. r.), M. D., F. R. C. P., 

Senior Physician to the Westminster Hospital, &c. 

AIDS TO THE DIAGNOSIS OF DISEASES OF THE KID- 
NEYS. With Ten large Plates. Sixty Illustrations. Price . $2.00 

Dr. Basham has been accustomed to make accurate notes and drawings of every case of 
renal disease coming under his notice. This volume contains a selection of the most important 
of these cases, with microscopical illustrations and letter-press descriptions, showing an 
amount of clinical experience that must prove of great value to those of the profession who 
have not had similar opportunities. 

2 



BLACK (D. CAMPBELL), M. D., 
L. R. C. S. Edinburgh, Member of the General Council of the University of Glasgow, &c, &c, 

THE FUNCTIONAL DISEASES OF THE RENAL, URINARY, 
and Reproductive Organs, with a General View of Urinary Pathology. 
Price ............ $2.50 

CONTENTS. 



Chap. 1. On the Conditions that affect the 
Secretion of the Urine, with special 
reference to Suppression. 

" 2. Retention of Urine; its Varieties, 
Causes, and Treatment. 

" 3. Irritable Bladder, Strangury. 



Chap. 4. On the Pathology and Treatment of 
Nocturnal Enuresis, and Spermatic 
Incontinence. 

" 5. Sterility in the Male. 

" 6. Male Impotence. 

" 7. Anomalous Urethral Discharges. 



The style of the author is clear, easy, and agreeable, . . . his work is a valuable contri- 
bution to medical science, and being penned in that disposition of unprejudiced philosophical 
inquiry which should always guide a true physician, admirably embodies the spirit of its 
opening quotation from Professor Huxley. — Plrilada. Med. Times. 



BEASLEY (henry). 

THE BOOK OF PRESCRIPTIONS. Containing over 3000 
Prescriptions, collected from the Practice of the most Eminent Physi- 
cians and Surgeons — English, French, and American; comprising also 
a Compendious History of the Materia Medica, Lists of the Doses of all 
Officinal and Established Preparations, and an Index of Diseases and 
their Remedies. Fourth Edition, Revised and Enlarged. Price, $2.50 

This new edition of Dr. Beasley's Prescription Book, although presented in a much more 
compact form and at a greatly reduced price, has been thoroughly revised, and an account 
of all the new medicines lately introduced, with the formulas of the new Pharmacopoeias 
added. Carefully selecting from the mass of materials at his disposal, the author has aimed 
to compile a volume sufficiently comprehensive, in which both physician and druggist, 
prescriber and compounder, may find under the head of each remedy the manner in which 
that remedy may be most effectively administered, or combined with other medicines in the 
treatment of disease. The alphabetical arrangement of the book renders this easy. A short 
description of each medicine is also given, and a list of the doses in which its several pre- 
parations may be prescribed. 

BY SAME AUTHOR. 

THE POCKET FORMULARY: A Synopsis of the British and 
Foreign Pharmacopceias. Ninth Revised Edition. Price . $2.50 

THE DRUGGIST'S GENERAL RECEIPT BOOK and VETERI- 
NARY FORMULARY. Seventh Edition. Price. . . $3.50 



BE ALE (Lionels.), M. D. 

DISEASE GERMS: AND ON THE TREATMENT OF DIS- 
EASES CAUSED BY THEM. 

Part L — SUPPOSED NATURE OF DISEASE GERMS. 
Pabt II. — REAL NATURE OF DISEASE GERMS. 
Part III. — THE DESTRUCTION OF DISEASE GERMS. 

Second Edition, much enlarged, with Twenty-eight full-page Plates, 
containing 117 Illustrations, many of them colored. Demy Octavo. 
Price ,. . . . $5.00 

This new edition, besides including the contents revised and enlarged of the two former 
volumes published by Dr. Beale on Disease Germs, has an entirely new part added on "The 
Destruction of Disease Germs." 

3 



BEALE (lionel s.)„ M. D., F. R. S. 

BIOPLASM. A Contribution to the Physiology of Life, or an Intro- 
duction to the Study of Physiology and Medicine, for Students. With 
Numerous Illustrations. Price . . . . . . $3.00 

This volume is intended as a Text-Book for Students of Physiology, explaining the 
nature of some of the most important changes which are characteristic of and peculiar to 
living beings. 

BY SAME AUTHOR. 
PROTOPLASM, OR MATTER AND LIFE. Third Edition, very 

much Enlarged. Nearly 350 pages. 16 Colored Plates. One volume. 

Price . . . . . . . . . . $5.00 

Pakt I. DISSENTIENT. Part II. DEMONSTRATIVE. Part III. SUGGESTIVE. 
This work contains : 1. Critical remarks on the life-theories advocated by Odling, Bence 
Jones, Grove, Owen, Huxley, Bennett, Bastian, Tyndall, Bain, Herbert Spencer, Darwin, and 
others. 2. A fall account of the author's own conclusions on the nature of life, and a state- 
ment of the facts and observations upon which they are based. 3. Many arguments against 
the scientific materialism of the day, and concludes with 4. A criticism on the theory of 
life advocated by Strauss in " The Old Faith and the New." 



BIDDLE (john b.), M. D., 

Professor of Materia Medica and Therapeutics in the Jefferson Medical College, Philadelphia, &c. 

MATERIA MEDICA, FOR THE USE OF STUDENTS. With 
Illustrations. Fifth Edition, Revised and Enlarged. Price $4.00 

This new and thoroughly revised edition of Professor Biddle's work has incorporated in 
it all the improvements as adopted by the New United States Pharinacopceia just issued. It 
is designed to present the leading facts and principles usually comprised under this head as 
set forth by the standard authorities, and to fall a vacuum which seems to exist in the want 
of an elementary work on the subject. The larger works usually recommended as text-books 
in our Medical schools are too voluminous for convenient use. This will be found to contain, 
in a condensed form, all that is most valuable, and will supply students with a reliable guide 
to the course of lectures on Materia Medica as delivered at the various Medical schools in 
the United States. 

BLOXAM (c. l.), 

Professor of Chemistry in King's College, London, 

CHEMISTRY, INORGANIC AND ORGANIC. With Experi- 
ments and a Comparison of Equivalent and Molecular Formulae. With 
276 Engravings on Wood. Second Edition, carefully revised. Octavo. 
Price $4.50 

The author has endeavored in this new edition of his work to supply a book sufficiently 
comprehensive for those studying the science as a branch of general education. He has also 
devoted sjiecial attention to Metallurgy and some other branches of applied Chemistry, in 
order to adapt it to the wants of practical men. His pages are crowded with facts and experi- 
ments, well chosen, and many of them quite new even to scientific men. 



CHAVASSE (p. henry), F. R. C. S., 

Author of Advice to a Wife, Advice to a Mother, &c. 

APHORISMS ON THE MENTAL CULTURE AND TRAIN- 
ING OF A CHILD, and on various other subjects relating to Health 
and Happiness. Addressed to Parents. Price . . . $i-5° 

Dr. Chavasse's works have been very favorably received and had a large circulation, the 
value of his advice to WIVES and MOTHERS having thus been very generally recognized. 
This book is a sequel or companion to them, and it will be found both valuable and important 
to all who have the care of families, and who want to bring up their children to become useful 
men and women. It is full of fresh thoughts and graceful illustrations. 

4 



CLARK (f. le gros), F. R. S., 

Senior Surgeon to St, Thomas's Hospital, 

OUTLINES OF SURGERY AND SURGICAL PATHOLOGY, 
including the Diagnosis and Treatment of Obscure and Urgent Cases, 
and the Surgical Anatomy of some Important Structures and Regions. 
Assisted by W. W. Wagstaffe, F. R. C. S., Resident Assistant-Surgeon 
of, and Joint Lecturer on Anatomy at, St. Thomas's Hospital. Second 
Edition, Revised and Enlarged. Price . . . . $3.00 

This edition brings the work up to the highest level of our present knowledge, incorporat- 
ing all that is sound and recent in Physiology so far as it relates to subjects requiring its 
aid. It is not alone an admirable exposition of the principles of Surgery, but a trusty guide 
to the emergencies of Practice. We cannot too highly estimate the ability to condense and 
the results of a ripened experience furnished to us here in a readable and practical form. — 
Med. Times and Gazette. 

COOLEY (a. j.). 

CYCLOPEDIA OF PRACTICAL RECEIPTS. Containing Pro- 
cesses' and Collateral Information in the Arts, Manufactures, Profes- 
sions, and Trades, including Medicine, Pharmacy, and Domestic 
Economy; designed as a General Book of Reference for the Manufac- 
turer, Tradesman, Amateur, and Heads of Families. The Fifth Edi- 
tion, Revised and partly Rewritten by Richard V. Tuson, F.C.S., &c. 
Over 1000 royal-octavo pages, double columns. With Illustrations. 
Price . . . . . . . . . . $10.00 

Every part of this edition has been subjected to a thorough and comiDlete revision by the 
editor, assisted by other scientific gentlemen. In the chemical portion of the book, every 
subject of practical importance has been retained, corrected, and added to ; to the name of 
every substance of established composition a formula has been attached ; while to the Phar- 
maceutist its value has been greatly increased by the additions which have been made from 
the British, Indian, and United States Pharmacopoeias. 

CAZEAUX (p.), M. D„, 

Adjunct Professor of the Faculty of Medicine, Paris, etc. 

A THEORETICAL AND PRACTICAL TREATISE ON MIDWIFERY, 

including the Diseases of Pregnancy and Parturition. Translated from 

the Seventh French Edition, Revised, Greatly Enlarged, and Improved, 

by S. Tarnier, Clinical Chief of the Lying-in Hospital, Paris, etc., 

with numerous Lithographic and other Illustrations. Price, in Cloth, 

$6.50; in Leather, $7.50. 

M. Cazeaux's Great Work on Obstetrics has become classical in its character, and almost 

an Encyclopaedia in its fulness. Written expressly for the use of students of medicine, its 

teachings are plain and ex23licit, presenting a condensed summary of the leading principles 

established by the masters of the obstetric art, and such clear, practical directions for the 

management of the pregnant, parturient, and jDuerperal states, as have been sanctioned by 

the most authoritative practitioners, and confirmed by the author's own experience. 

DOBELL (horace), M. D., 

Senior Physician to the Hospital. 

WINTER COUGH (CATARRH, BRONCHITIS, EMPHYSEMA, 
ASTHMA). Lectures Delivered at the Royal Hospital for Diseases of the 
Chest. New and Enlarged Edition, with Colored Plates. Octavo. 
Price $3.50 

This work has been thoroughly revised. Two new Lectures have been added — viz., 
Lecture IV., " On the Natural Course of Neglected Winter Cough, and on the Interdepen- 
dence of Winter Cough with other Diseases ; " Lecture IX., " On Change of Climate in Winter 
Cough." Also additional matter on Post-nasal Catarrh, Ear-Cough, Artificial Respiration as 
a means of Treatment, Laryngoscopy, New Methods and Instruments in Treating of Emphy- 
sema, a good Index, and Colored Plates, with appended Diagnostic Physical signs. 

5 



DALBY (w. b.), F.R.C.S., 

Aura! Surgeon to St. George's Hospital. 

LECTURES ON THE DISEASES AND INJURIES OF THE 
EAR. Delivered at St. George's Hospital. With Illustrations. 

Price '• $i-5° 

This admirable little volume by Mr. Dalby, the accomplished aural surgeou to St. George's 
Hospital, consists of eleven lectures delivered by him at that institution. With a modest 
aim, this work, the latest issued by the English press on Aural Surgery, is happy in concep- 
tion and pleasantly written ; further, it shows that its author is thoroughly au fait in his 
specialty. The subject of which the volume treats is handled in a terse style, and this, if 
we mistake not, will make it acceptable to the student and practitioner who have a just 
horror of unnecessary details. In conclusion, we hope that we have succeeded in interesting 
our readers in the volume. We cordially recommend it as a trustworthy guide in the treat- 
ment of the affections of the ear. The book is moderate in price, beautifully illustrated by 
wood-cuts, and got up in the best style. — Glasgow Medical Journal. 



ELLIS (EDWARD), M. D. 
Physician to the Victoria Hospital for Sick Children, &c. 

A PRACTICAL MANUAL OF THE DISEASES OF CHIL- 
DREN, with a Formulary. Second Edition, Revised and Improved. 
One volume. ......... $2.75 

The AUTHOR, in issuing this new edition of his book, says : "I have very carefully revised 
each chapter, adding several new sections, and making considerable additions where the 
subjects seemed to require fuller treatment, without, however, sacrificing conciseness or 
unduly increasing the bulk of the volume." 



FOTHERGILL (j. milner), M. D. 

THE HEART AND ITS DISEASES, AND THEIR TREAT- 
MENT. With Illustrations. Octavo. Price . . . #5.00 

This work gives to the reader a concise view of Cardiac Diseases, uniting the most recent 
information as to the cause of heart-disease, with German Pathology and the latest advances 
in Therapeutics. It is designed to fill the gap between our standard works and the present 
position of our knowledge in diseases of the heart. 

BY SAME AUTHOR. 

DIGITALIS. Its Mode of Action and its Use, illustrating the 
Effect of Remedial Agents over Diseased Conditions of the Heart. 
Price $*- 2 5 



GANT (FREDERICK J.), F. R. C. S., 
Surgeon to the Royal Free Hospital, &c, 

THE IRRITABLE BLADDER. Its Causes and Curative Treat- 
ment ; including a Practical View of Urinary Pathology, Deposits, and 
Calculi. Third Edition, Revised and Enlarged. With New Illustra- 
tions. Price ......... $2.50 

The fact that a third edition of this book has been required seems to be sufficient proof 
of its value. The author has carefully revised and added such additional matter as to make 
it moi-e complete and practically useful. 



DAWSON (c), M. A., PH. D. 

Lecturer on Photography in King's College, London. 

HARDWICK'S MANUAL OF PHOTOGRAPHIC CHEMISTRY 

With Engravings. Eighth Edition. Edited and Re-arranged by G. 
Dawson, Lecturer on Photography, &c, &c. i2mo. . $2.00 

The object of the Editor has been to give practical instruction in this fascinating art, and 
to lead the novice from first principles to the higher branches, impressing him with the value 
of care and exactness in every operation. 

HARLEY (george), M. D., F. R. C. P., 

Physician to University College Hospital. 

THE URINE AND ITS DERANGEMENTS: With the Applica- 
tion of Physiological Chemistry to the Diagnosis and Treatment of 
Constitutional as well as Local Diseases; being a Course of Lectures 
delivered at University College. With Engravings. Price $2.75 

CONTENTS. 

7. Phosphoric Acid, Phosj>hatic Gravel and 
Calculi. 

8. Oxalic Acid, Oxaluria, Mulberry Calculi. 

9. Inosite in Urine, Creatin and Creatinine, 
Cholesterin, Cystin, Xanthin, Leucin, 



1. What is Urine? 

2. Changes in the Composition of the Urine, 

induced by Food, Drink, Medicine, and 
Disease. 

3. Urea, Ammonsemia, Uraemia. 

4. Uric Acid. 

5. Hippuric Acid, Chloride of Sodium. 

6. Urohsematin, Abnormal Pigments in Urine. 



Tyrosin. 

10. Diabetes Mellitus. 

11. Albuminuria. 



On the whole, we have here a valuable addition to the library of the practising physician ; 
not only for the information which it contains, but also for the suggestive way in which 
many of the subjects are treated, as well as for the fact that it contains the ideas of one who 
thoroughly believes in the future capabilities of Therapeutics based on Physiological facts, 
and in the important service to be rendered by Chemistry to Physiological investigation. 

American Journal of the Medical Science. 

HABERSHON (s. 0.), M. D., 

Physician to Guy's Hospital, &c. 

ON THE DISEASES OF THE LIVER. Their Pathology and 
Treatment. Being the Lettsonian Lectures, delivered at the Medical 
Society of London, 1872. Price $ I -5° 

These Lectures contain within a brief compass a large amount of information and many 
practical suggestions that cannot fail to be of great value to every practitioner. 

Dublin Medical Journal. 

HEWITT (graily), M. D., 

Physician to the British Lying-in Hospital, and Lecturer on Diseases of Women and Children, &c. 

THE DIAGNOSIS, PATHOLOGY, AND TREATMENT OF 

DISEASES OF WOMEN, including the Diagnosis of Pregnancy. 

Founded on a Course of Lectures delivered at St. Mary's Hospital 

Medical School. The Third Edition, Revised and Enlarged, with 

new Illustrations. Octavo. Price in Cloth . . . $5. 00 

" Leather . . . 6.00 

This new edition of Dr. Hewitt's book has been so much modified, that it may be considered 

substantially a new book ; very much of the matter has been entirely rewritten, and the whole 

work has been rearranged in such a manner as to present a most decided improvement over 

previous editions. Dr. Hewitt is the leading clinical teacher on Diseases of Women in London, 

and the characteristic attention paid to Diagnosis by him has given his work great popularity 

there. It may unquestionably be considered the most valuable guide to correct Diagnosis to 

be found in the English language. 7 



HEWSON (addinell,) M. D. 

Attending Surgeon Pennsylvania Hospital, &c. 

EARTH AS A TOPICAL APPLICATION IN SURGERY. 
Being a full Exposition of its use in all the Cases requiring Topical 
Applications admitted in the Surgical Wards of the Pennsylvania Hospi- 
tal during a period of Six Months. With Four full-page Illustrations. 
CONTENTS. 
Preface; Introduction; Histories of Cases ; Comments as to the Effects of tlie Contact of 

the Earth ; Its Effects on Pain ; Its Power as a Deodorizer ; Its Influence over Inflammation ; 

Its Influence over Putrefaction; Its Influence over the Healing Processes; Modus Operandi 

of the Earth ; As a Deodorizer and other Putrefaction ; In its Effects on Living Parts. 

Price, ........... $2.50 

It presents the results of researches by the author into the action of Earth as a surgical 
dressing, and embraces the histories of over ninety cases which occurred in the wards of the 
Pennsylvania Hospital some three years since, but whose publication has been delayed, for 
the double purpose of weighing them by subsequent experience, and of interpreting their 
- '-y a careful study of the various subjects which they involve. 



HODGE (hugh l.), M. D. 

Emeritus Professor in the University of Pennsylvania. 

HODGE ON FOETICIDE, OR CRIMINAL ABORTION. 

Fourth Edition. Price, in paper covers, .... $0.30 

" flexible cloth, . . . .0.50 

This little book is intended to place in the hands of professional men and others the means 
of answering satisfactorily and intelligently any inquiries that may be made of them in con- 
nection with this important subject. 

HOLDEN (edgar), A. M., M. D., 

Of Newark, New Jersey. 
CONTAINING THREE HUNDRED ILLUSTRATIONS. 
THE SPHYGMOGRAPH. Its Physiological and Pathological In- 
dications. The Essay to which was aAvarded the Stevens Triennial 
Prize in the College of Physicians and Surgeons in New York, April, 
1873. Illustrated by Three Hundred Engravings on Wood. One vol- 
ume octavo. Price. ........ $ 

LEBER & ROTTENSTEIN (drs.). 

DENTAL CARIES AND ITS CAUSES. An Investigation into 
the Influence of Fungi in the destruction of the Teeth, translated by 
Thomas H. Chandler, D.M.D., Professor of Mechanical Dentistry in 
the Dental School of Harvard University. With Illustrations. Octavo. 
Price $1-50 

This work is now considered the best and most elaborate work on Dental Caries. It is 
everywhere quoted and relied upon as authority by the profession, who have seen it in the 
original, and by authors writing on the subject. 

LEGG (j. wickham), M. D. 

Member of the Royal College of Physicians, &c, 

A GUIDE TO THE EXAMINATION OF THE URINE. For 

the Practitioner and Student. Third Edition. i6mo. Cloth. Price, $0. 75 

Dr. Legg's little manual has met with remarkable success; the speedy exhaustion of two 
editions has enabled the author to make certain emendations which add greatly to its value. 
It can confidently be commended to the student as a safe and reliable guide. 



LEWIN (dr. george). 

Professor at the Fr.-Wilh. University, and Surgeon-in-Chief of the Syphilitic Wards and Skin Diseases of 
the Charity Hospital, Berlin. 

THE TREATMENT OF SYPHILIS by Subcutaneous Sublimate 
Injections. With a Lithographic Plate illustrating the Mode and Proper 
Place of administering the Injections, and of the Syringe used for the 
purpose. Translated by Carl Prcegler, M.D., late Surgeon in the 
Prussian Service, and E. H. Gale, M.D., late Surgeon in the United 

States Army. Price $2.25 

The great number of cases treated, some fourteen hundred, within a period of four years, 
in the wards of the Charity Hospital, Berlin, only twenty of which were returned on 
account of Syphilitic relapses, certainly entitles the method of treatment advocated by this 
distinguished syphilographer to the attention of all physicians under whose notice syphilitic 
cases come. 

LIZARS (john), M. D. 

Late Professor cf Surgery in the Royal College of Surgeons, Edinburgh, 

THE USE AND ABUSE OF TOBACCO. From the Eighth 
Edinburgh Edition. i2mo. Price, in flexible cloth, . $0.60 

This little work contains a History of the introduction of Tobacco, its general characteris- 
tics ; practical observations upon its effects on the system ; the opinion of celebrated profes- 
sional men in regard to it, together with cases illustrating its deleterious influence, &c, &c. 

MACNAMARA (a). 

Surgeon to the Ophthalmic Hospital, and Professor of Ophthalmic Medicine in the Medical College, Calcutta, 

MANUAL OF THE DISEASES OF THE EYE. The Second 

Edition, carefully Revised; with Additions, and numerous Colored 

Plates, Diagrams of the Eye, many Illustrations on Wood, Snellen's 

Test Types, &c, &c. Price . . . . . $5-°° 

" This work when first published took its place in medical literature as the most complete, 

condensed, and well-arranged manual on ophthalmic surgery in the English language. 

Arranged especially for medical students, it became, however, the work of reference for the 

busy practitioner, who could obtain nearly all that was best worth knowing on this subject, 

tersely stated, and easily found by the aid of the excellent marginal notes on the contents 

of the paragraphs." — Philadelphia Medical Times. 

MACKENZIE (morell), M. D. 

Physician to the Hospital for Diseases of the Throat, London, &c. 

GROWTHS IN THE LARYNX. Their History, Causes, Symp- 
toms, Diagnosis, Pathology, Prognosis, and Treatment. With Reports 
and Analysis of One Hundred Consecutive Cases treated by the Author ; 
and a Tabular Statement of every published case treated since the in- 
vention of the Laryngoscope. With numerous Colored and other 
Illustrations. Octavo. Price ...... $3.00 

Dr. Mackenzie's position has given him great advantages and a large experience in the 

treatment of Diseases of the Throat, and for many years he has been regarded as a leading 

authority in this department of Surgery. The Illustrations have been prepared with great 

care and expense. 

OTHER WORKS BY SAME AUTHOR. 

THE LARYNGOSCOPE IN DISEASES OF THE THROAT. 

With an Appendix on Rhinoscopy, and an Essay on Hoarseness and 
Loss of Voice. With Additions by J. Sous Cohen, and Numerous 
Illustrations on Wood and Stone. Price .... $3-oo 

PHARMACOPOEIA OF THE HOSPITAL for Diseases of the 
Throat; with One Hundred and Fifty Formulae for Gargles, &c, &c. 

Price 3S1.25 

9 



MAUNDER (c. f.), F. R. C. S. 

Surgeon to the London Hospital; formerly Demonstrator of Anatomy at Guy's Hospital. 

OPERATIVE SURGERY. Second Edition, with One Hundred 
and Sixty-four Engravings on Wood. 
CONTENTS. 



Chap. 1. Compress, Splint, Bandage Strap' 
ping. 

2. Ligature. 

3. Operations on the Vascular System 

4. Operations on Arteries. 

5. Ligature of special ditto. 

6. Operations on the Bones. 
Price . . . . . . . . . .$2.50 



Chap. 7. Operations on the Surfaee of tha 
Body. _ 
" 8. Amputation. 
" 9. Lower Extremity. 
" 10. Upper ditto. 
" 11. Special Operations. 



MARTIN (john h.). 

Author of Microscopic Objects, &c. 

A MANUAL OF MICROSCOPIC MOUNTING. With Notes on 
the Collection and Examination of Objects, and upwards of One Hun- 
dred Illustrations on Stone and Wood, drawn by the Author. 
Price $3-oo 

" This book is more than its title indicates. It gives a description of the apparatus neces- 
sary for microscopical research, as well as the methods of preparation and preserving the 
various objects. It is a complete and well-illustrated work on its subject, which is daily 
becoming more valuable to. the scientist and more cultivated as an elegant and interesting 

study." — Scientific American. • 

MEADOWS (alfred), M. D. 

Physician to the Hospital for Women, and to the General Lying-in Hospital, &c, 

MANUAL OF MIDWIFERY. A New Text-Book. Including the 
Signs and Symptoms of Pregnancy, Obstetric Operations, Diseases of 
the Puerperal State, &c, &c. First American from the Second London 
Edition. With numerous Illustrations. Price . . . $3.00 

This book is especially valuable to the Student as containing in a condensed form a lar.ee 
amount of valuable information on the subject which it treats. It is also clear and methodi- 
cal in its arrangement, and therefore useful as a work of reference for the practitioner. The 
Illustrations are numerous and well executed. 

MILLER (james), F. R. C. S. 

Professor of Surgery University of Edinburgh, 

ALCOHOL, ITS PLACE AND POWER. From the Nineteenth 
Glasgow Edition. i2ino. Cloth flexible. Price . . . $0.75 

This work was prepared by Professor Miller at the special request of the Scottish Temper- 
ance League, who were anxious to have a work of high authority, presenting the medical 
view of the subject that could be freely disseminated among all classes. 



NORRIS (GEORGE w.), M.D. 
Late Surgeon to the Pennsylvania Hospital, &c, 

CONTRIBUTIONS TO PRACTICAL SURGERY, including 
numerous Clinical Histories, Drawn from a Hospital Service of Thirty 

Years. In one volume, Octavo. Price $4.00 

10 



RINDFLEISCH (dr. edward). 

Professor of Pathological Anatomy, University of Bonn, 

TEXT-BOOK OF PATHOLOGICAL HISTOLOGY. An Intro- 

duction to the Study of Pathological Anatomy. Translated from the 
German, by Wm. C. Kloman, M.D., assisted by F. T. Miles, M.D., 
Professor of Anatomy, University of Maryland, &c., &c. Containing 
Two Hundred and Eight elaborately executed Microscopical Illustra- 
tions. Octavo. Price, bound in Cloth, . . . . $6.00 
" " Leather, .... 7.00 

This is now confessedly the leading book, and the only complete one on the subject in 
the English language. The London Lancet says of it : " Rindneisch's work forms a mine 
which no pathological writer or student can afford to neglect, who desires to interpret aright 
pathological structural changes, and his book is consequently well kuown to readers of Ger- 
man medical literature. What makes it especially valuable is the fact that it was originated, 
as its author himself tells us, more at the microscope than at the writing-table. Altogether 
the book is the result of honest hard labor. It is admirably as well as profusely illustrated, 
furnished with a capital Index, and got up in a way that is worthy of what must continue 
to be the standard book of the kind." 

ROBERTS (FREDERICK T.)., M. D., B.Sc. 

Assistant Physician and Teacher of Clinical Medicine in the University College Hospital ; Assistant Physician 
Brompton Consumption Hospital, &c. 

A HAND-BOOK OF THE THEORY AND PRACTICE OF 
MEDICINE; One volume medium octavo, containing over 1000 
pages. Price . . . $5.00. 

This work has been prepared mainly for the use of Students, and its object is to 
present in as condensed a form as the present extent of Medical Literature will permit, 
and in one volume, such information with regard to the Principles and Practice of 
Medicine, as shall be sufficient not only to enable them to prepare for the various 
examinations whicli they may have to undergo, but also to guide them in acquiring 
that Clinical Knowledge which can alone properly fit them for assuming the active 
duties of their profession. The work is also adapted to the wants of very many 
members of the profession who are already busily engaged in general Practice, and 
consequently have but little leisure and few opportunities for the perusal of the larger 
works on Practice or of the various special monographs. 



REYNOLDS (j. russell), M. D., F. R. S., 

Lecturer on the Principles and Practice of Medicine, University College, London. 

LECTURES ON THE CLINICAL USES OF ELECTRICITY. 

Delivered at University College Hospital. Second Edition, Revised 
and Enlarged. Price $ 

RYAN (MICHAEL), M. D. 

Member of the Royal College of Physicians. 

PHILOSOPHY OF MARRIAGE, in its Social, Moral, and Physi- 
cal Relations ; with an Account of the Diseases of the Genito-Urinary 
Organs, &c. Price ........ $1.00 

This is a philosophical discussion of the whole subject of Marriage, its influences and 
results in all their varied aspects, together with a medical history of the reproductive func- 
tions of the vegetable and animal kingdoms, and of the abuses and disorders resulting from 
it in the latter. It is intended both for the professional and general reader. 

11 



SWERINGEN (hiram v.). 

Member American Pharmaceutical Association, &c. 

PHARMACEUTICAL LEXICON. A Dictionary of Pharmaceu- 
tical Science. Containing a concise explanation of the various subjects 
and terms of Pharmacy, with appropriate selections from the collateral 
sciences. Formulse for officinal, empirical, and dietetic preparations; 
selections from the prescriptions of the most eminent physicians of 
Europe and America; an alphabetical list of diseases and their defini- 
tions; an account of the various modes in use for the preservation of 
dead bodies for interment or dissection ; tables of signs and abbrevia- 
tions, weights and measures, doses, antidotes to poisons, &c, &c. 
Designed as a guide for the Pharmaceutist, Druggist, Physician, &c. 

Royal Octavo. Price in cloth $5-°o 

" leather ...... 6.00 

" We have received from publishers so many English reprints ill adapted to the needs of 
this country, that it is with pleasure we welcome a thorough American book, written for the 
uses of the American pharmaceutist. Besides, the work is well written, creditably arranged, 
and neatly printed. It will be found very useful to the druggist as well as to the physician. 
Being in the form of a dictionary, its aim is to give immediate information in a concise man- 
ner, and not a complete treatise on each subject. So far as we have been able to see, the 
Pharmaceutical Lexicon is remarkably correct. " — Druggist's Circular. 
t 

SHEPPARD (edgar), M. D. 

Professor of Psychological Medicine in King's College, London. 

MADNESS, IN ITS MEDICAL, SOCIAL, AND LEGAL AS- 
PECTS. A series of Lectures delivered at King's College, London. 
Octavo. Price $2.50 

SAVAGE (henry), M. D., F. R. C. S. 

Consulting Physician to the Samaritan Free Hospital, London. 

THE SURGERY, SURGICAL PATHOLOGY, and Surgical Anat- 
omy of the Female Pelvic Organs, in a Series of Colored Plates 
taken from Nature : with Commentaries, Notes, and Cases. Third 
Edition, greatly enlarged. A quarto volume. Price 

TANNER (thomas hawkes), M. D., F. R. C. S., &c. 

MEMORANDA OF POISONS. A New and much enlarged Edi- 
tion. Price . . . . . . . $°-75 

This manual is intended to assist the practitioner in the diagnosis and treatment of poison- 
ing, and especially to prevent his attributing to natural disease symptoms due to the admin- 
istration of deadly drugs. 

OTHER WORKS BY SAME AUTHOR. 

THE PRACTICE OF MEDICINE. Fifth American Edition, $6.00. 

A PRACTICAL TREATISE ON THE DISEASES OF INFANCY 
AND CHILDHOOD. Third American Edition, . . . $3.50. 

AN INDEX OF DISEASES, AND THEIR TREATMENT, $3.00. 

" Dr. Tanner has always shown in his writings that he possesses a peculiar faculty of com- 
mitting to print just that kind of information which the practitioner most needs in every-day 
practice, and of rejecting useless theory." — Lancet. 

12 



THOROWGOOD (j. a), M. D. 

Physician to the City of London Hospital for Diseases of the Chest, and to the West London Hospital, &c. 

NOTES ON ASTHMA. Its various Forms, their Nature and 
Treatment, including Hay Asthma, with an Appendix of Formulae, &c. 
Second Edition. Price $!-75 

TOMES (john), F.R.S. 

Late Dental Surgeon to the Middlesex and Dental Hospitals, &c, 

A SYSTEM OF DENTAL SURGERY. The Second Revised and 
Enlarged Edition, by Charles S. Tomes, M.A., Lecturer on Dental 
Anatomy and Physiology, and Assistant Dental Surgeon to the Dental 
Hospital of London. With 263 Illustrations. Price . . $5.00 

This book has been for some time out of print in this country. The material progress made 
in the science of Dental Surgery since its first publication has rendered large additions and 
many revisions necessary to the New Edition : in order to bring it fully up to the time ; this 
has been done without increasing the size of the book more than possible. Many improve- 
ments, however, will be found added to the Text, and some Sixty new illustrations are in- 
corporated in the volume. 

TROUSSEAU (a.), M. D. 

Professor of Clinical Medicine to the Faculty of Medicine, Paris; Physician to the Hotel Dieu, &c, &c, 

LECTURES ON CLINICAL MEDICINE. Delivered at the Hotel 
Dieu, Paris. Vol. I. Translated with Notes and Appendices, by P. 
Victor Bazine, M.D., London and Paris. Vols. II., III., IV., and 
V., Translated from the Third Revised and Enlarged Edition, under 
the auspices of the Sydenham Society, by John Rose Cormack, M.D., 
Edinburgh; M.D., Paris, F.R.S.E., &c. 
Price of Vols. 1, 2, and 3, each, ...... $5.00 

" " 4 and 5 " • • • • ■ • 4-oo 

A Complete Edition, in 2 vols, octavo, can also now be furnished. 

Price bound in Cloth $10.00 

" " Leather 12.00 

TUKE (DANIEL s.), M. D. 
Associate Author of "A Manual of Psychological Medicine," &c. 

ILLUSTRATIONS OF THE INFLUENCE OF THE MIND 
UPON THE BODY. Octavo. Price . . . . $4.00 

The author shows very clearly in this book the curative influence of the mind, as well as 
its effect in causing disease, and the use of the imagination and emotions as therapeutic 
agents. His object is also to turn to the use of legitimate medicine the means so frequently 
employed successfully in many systems of quackery. 



TIBBITS (HERBERT), M. D. 
Medical Superintendent of the National Hospital for the Paralyzed and Epileptic, die. 

A HANDBOOK OF MEDICAL ELECTRICITY. With Sixty- 
four large Illustrations. Small octavo. Price . . . $2.00 

The author of this volume is the translator of Duchenne's great work on " Localized Elec- 
trization." Avoiding contested points in electro-physiology and therapeutics, he has pre- 
pared this handbook as containing all that is essential for the busy practitioner to know, not 
only when, but in EXPLICIT AND FULL DETAIL, how to use Electricity in the treatment of 
disease, and to make the practitioner as much at home in the use of his electrical as his 
other medical instruments. 

13 



WILSON (george), M. A., M. D. 

Medical Officer to the Convict Prison at Portsmouth. 

A HANDBOOK OF HYGIENE AND SANITARY SCIENCE. 

With Engravings. Second Edition, carefully Revised. 
CONTENTS. 



Chap. 1. Introductory — Public Health and 
Preventable Disease. 

" 2. Food — Construction of Dietaries ; 
Examination ; Effects of Un- 
wholesome Food. 

" 3. Air : its Impurities ; Unwholesome 
Trades. 

" 4. "Ventilation and Warming. 

" 5. Examination of Air. 

" 6. Water, Waterworks, Water Analy- 
sis. 

" 7. Effects of Impure Water on Public 
Health. 

" 8. Dwellings, Structural Arrange- 
ments, Dwellings of the Poor. 

" 9. Hospitals; Plans of Pavilion, Cot- 
Price 



tage, and Contagious Diseases 
Hospitals. 
Chap. 10. Removal of Sewage and Refuse 
Matter. 
" 11. Purification and Utilization of 

Sewage. 
" 12. Effects of Improved Sewerage and 

Drainage on Public Health. 
" 13. Preventive Measures ; Disinfec- 
tion ; Management of Epidemics. 
" 14. Duties of Medical Officers of 
Health. 
Appendix I. Excerpts from the various 
Public Health and Sanitary Acts. 
II. List of Analytical Apparatus and Re- 
agents, with prices. 

$2.50 



WARD (stephen h.), M.D., F. R. C. P. 

Physician to the Seaman's Hospital, &c.j &c. 

ON SOME AFFECTIONS OF THE LIVER and Intestinal Canal; 
with Remarks on Ague and its Sequelae, Scurvy, Purpura, &c. 
Price . . . . . . . . . . . $3.00 

" Dr. Ward's book is of a purely practical character, embodying the author's experience, 
from his long connection as physician to the Seaman's Plospital. His accurate description 
of the diseases treated will amply repay the reader." — Dublin Medical Journal. 

WILSON (erasmus), F.R.C.S., &c. 

CONTAINING THREE HUNDRED AND SEVENTY-ONE ILLUSTRATIONS. 

THE ANATOMIST'S VADE MECUM. A Complete System of 
Human Anatomy. The Ninth Revised and Enlarged London Edition. 
Edited and fully brought to the Science of the day by Prof. George 
Buchanan, Lecturer on Anatomy in Anderson's University, Glasgow, 
with many New Illustrations, prepared expressly for this Edition. 
Price $5.50 



WEDL (carl), M.D. 

Professor of Histology, &c, in the University of Vienna. 

DENTAL PATHOLOGY. The Pathology of the Teeth. With 
Special Reference to their Anatomy and Physiology. First American 
Edition, translated by W. E. Boardman, M.D., with Notes by Thos. 
B. Hitchcock, M.D., Professor of Dental Pathology and Therapeutics 
in the Dental School of Harvard University, Cambridge. With 105 
Illustrations. . . . Price, in Cloth, $4. 50 ; Leather, $5.50 

This work exhibits laborious research and medical culture of no ordinary character. It 
covers the entire field of Anatomy, Physiology, and Pathology of the Teeth. The author, 
Prof. Wedl. has thoroughly mastered the subiect, using with great benefit to the book the 
very valuable material left by the late Dr. Heider, Professor of Dental Pathology in the Uni- 
versity of Vienna, the result of the life-long work of this eminent man. 

14 



CONDENSED LIST 

OF ALL THE 

MEDICAL PUBLICATIONS 

OF 

LINDSAY & BLAKISTON, 

PHILADELPHIA. 



AITKEN'S SCIENCE AND PRACTICE OF MEDICINE. Third American, 
from the Sixth London Edition. In Two Volumes, Eoyal Octavo. Over 2000 pages. 
With a Colored Map, Lithographic Plate, and nearly Two Hundred Illustrations on 
Wood Cloth, $12 ; Leather, $14.00. 

ATTHILL'S CLINICAL LECTURES ON DISEASES PECULIAR TO 

WOMEN. Second Edition, Eevised and Enlarged, with Illustrations. . $2.25. 

AGNEW'S LACERATIONS OF THE FEMALE PERINEUM AND 
VESICO- VAGINAL FISTULA. Numerous Illustrations. 8vo. . . $2.00. 

ACTON ON THE FUNCTIONS AND DISORDERS OF THE REPRO- 
DUCTIVE OEGANS. Third American Edition. Octavo. . . . $3.00. 

ACTON ON PROSTITUTION, in its Moral, Social, and Sanitary Aspects. 
Second Edition. ......... $5.00. 

ALLINGHAM ON FISTULA, HiEMORRHOIDS, PAINFUL ULCER, 
STEICTUEE, PEOLAPSUS, and Diseases of the Eectum. Second Edition. $2.00. 

ADAMS ON CLUB-FOOT, its Causes, Pathology, and Treatment. Second Edition. 
With Numerous Lithographic and Wood-Cut Illustrations. . . . $6.00. 

ADAMS ON RHEUMATIC AND STRUMOUS DISEASES OF THE 
JOINTS. With a quarto Atlas of Plates and other Illustrations. 2 Vols. $8.50. 

ANSTIE ON STIMULANTS AND NARCOTICS, their Mutual Eelations, 
and on the Action of Alcohol, Ether, and Chloroform on the Vital Organism. $3.00. 

ALTHAUS' MEDICAL ELECTRICITY, its Use in the Treatment of Paralysis, 
Neuralgia, and other Diseases. Third Edition. Enlarged and Eevised. . $6.00. 

BYPORD'S PRACTICE OF MEDICINE AND SURGERY. Applied to the 
Diseases and Accidents Incident to Women. Second Edition. . . $5.00. 

BYFORD ON THE CHRONIC INFLAMMATION AND DISPLACE- 
MENT OF THE UNIMPEEGNATED UTEKUS. Second Edition. With 
Numerous Illustrations. ........ $3.00. 

BLACK ON THE FUNCTIONAL DISEASES OF THE RENAL, URI- 

NAEY, AND EEPEODUCTIVE OEGANS $2.50. 

BLOXAM'S CHEMISTRY, INORGANIC AND ORGANIC. With 276 

Engravings on Wood. Second Edition, carefully revised. Octavo. . . $4.50. 

BLOXAM'S LABORATORY TEACHING; OR, PROGRESSIVE EX- 
ERCISES IN PEACTICAL CHEMISTEY. Second Edition. Illustrations. $2.25. 



BRUNTONS EXPERIMENTAL INVESTIGATION OP THE ACTION 

OF MEDICINES. In preparation. 

BEETON'S BOOK OP HOUSEHOLD MANAGEMENT. 672 Illustrations, 
1,100 pages. ......... $3.25. 

BRANSTON'S HAND-BOOK OF PRACTICAL RECEIPTS, for the 

Chemist, Druggist, &c. With a Glossary of Chemical Terms. . . $1 .50. 

BRODHTJRST ON THE DEFORMITIES OF THE HUMAN BODY. 
A System of Orthopedic Surgery. Illustrated. .... $3.00. 

BEASLEY'S 3000 PRESCRIPTIONS, from the Practice of the most Eminent 
Physicians and Surgeons — English, French, and American. Fourth Edition. $2.50. 

BEASLEY'S DRUGGISTS' GENERAL RECEIPT-BOOK AND VETE- 
RINARY FORMULARY. Seventh Edition, Revised and Improved. . $3.50. 

BEASLEY'S POCKET FORMULARY. The Ninth London Edition, Revised 
and Enlarged. ......... $2.50. 



BARTH & ROGER'S MANUAL OF AUSCULTATION AND PERCUS- 
SION. From the Sixth French Edition. . ... . . $1.25. 

BOUCHARDAT'S ANNUAL ABSTRACT of Therapeutics, Materia Medica, 
Pharmacy, and Toxicology, for 1867. ...... $1.50. 

BEALE'S HOW TO WORK WITH THE MICROSCOPE. Fourth Edition. 
400 Illustrations. ........ $7.50. 

BEALE ON KIDNEY DISEASES, URINARY DEPOSITS, AND 
CALCULOUS DISORDERS. Third Edition. 70 Plates, 415 Figures. . $10.00. 

BEALE'S USE OF THE MICROSCOPE IN PRACTICAL MEDICINE. 

Fifth Edition. 500 Illustrations. In preparation. 

BEALE'S BIOPLASM. A New Introduction to the Study of Physiology and 
Medicine, for Students. With Plates. ...... $3.00. 

BEALE'S LIFE, MATTER, AND MIND; OR PROTOPLASM. Third 

Edition, very much enlarged. Sixteen Colored Plates. . . . $5.00. 

BEALE'S DISEASE GERMS; AND ON THE TREATMENT OP 

DISEASES CAUSED BY THEM. Second Edition. Much Enlarged. . $5.00. 

BIDDLE'S MATERIA MEDICA. For the Use of Students. With Illustrations. 
Fifth Edition. Revised and Enlarged. ..... $4.00. 

BASHAM'S AIDS TO THE DIAGNOSIS OF DISEASES OF THE 

KIDNEYS. Ten Plates, 60 Figures. $2.00. 

BIRCH ON CONSTIPATED BOWELS. The Various Causes and Means of 
Cure. Third Edition. . . . . • . . . $1.00. 

BRAITHWAITE'S EPITOME OF THE RETROSPECT OF PRACTICAL 

MEDICINE AND SURGERY. 2 Vols $10.00. 

CHAMBERS ON THE RENEWAL OF LIFE. Lectures chiefly Clinical, 
illustrative of a Restorative System of Medicine. Fourth Edition. . . $5.00. 

CHEW ON MEDICAL EDUCATION. A Course of Lectures on the Proper 
Method of Studying Medicine. ....... $1.00. 

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